Provider Demographics
NPI:1093957599
Name:KELLY, RONNIE E (LMBT)
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:E
Last Name:KELLY
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 ICEBURG LN
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-8780
Mailing Address - Country:US
Mailing Address - Phone:828-506-7010
Mailing Address - Fax:
Practice Address - Street 1:23 HENSLEY CIR
Practice Address - Street 2:SUITE D
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2834
Practice Address - Country:US
Practice Address - Phone:828-586-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3779174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist