Provider Demographics
NPI:1720314420
Name:QUINN, KELLY (FNP-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1844
Mailing Address - Street 2:
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713-1844
Mailing Address - Country:US
Mailing Address - Phone:828-785-5301
Mailing Address - Fax:828-538-4441
Practice Address - Street 1:1900 RANDOLPH RD STE 1016
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207
Practice Address - Country:US
Practice Address - Phone:704-347-3447
Practice Address - Fax:704-347-3440
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004545363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9242002OtherCIGNA
NC169PAOtherBCBS NC
NCNCH095COtherMEDICARE
NCP02008773OtherRR MEDICARE