Provider Demographics
NPI:1912671843
Name:KERLEY, MIRANDA (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:KERLEY
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2544 PRINCESS POND RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERTON
Mailing Address - State:SC
Mailing Address - Zip Code:29148-8446
Mailing Address - Country:US
Mailing Address - Phone:843-609-2033
Mailing Address - Fax:
Practice Address - Street 1:1056 FELTON ST
Practice Address - Street 2:
Practice Address - City:SUMMERTON
Practice Address - State:SC
Practice Address - Zip Code:29148-7169
Practice Address - Country:US
Practice Address - Phone:843-819-4021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily