Provider Demographics
NPI:1376089714
Name:TURNER, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 NC 410 HWY
Mailing Address - Street 2:
Mailing Address - City:BLADENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28320-8053
Mailing Address - Country:US
Mailing Address - Phone:910-809-0021
Mailing Address - Fax:910-809-0021
Practice Address - Street 1:2105 NC 410 HWY
Practice Address - Street 2:
Practice Address - City:BLADENBORO
Practice Address - State:NC
Practice Address - Zip Code:28320-8053
Practice Address - Country:US
Practice Address - Phone:910-809-0021
Practice Address - Fax:910-809-0021
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-009-030310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility