Provider Demographics
NPI:1912598475
Name:PEREZ, KELLIE WALKER (FNP-C, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:WALKER
Last Name:PEREZ
Suffix:
Gender:F
Credentials:FNP-C, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 TRADD AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-8131
Mailing Address - Country:US
Mailing Address - Phone:704-974-4888
Mailing Address - Fax:
Practice Address - Street 1:301 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3020
Practice Address - Country:US
Practice Address - Phone:864-208-1960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24435363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily