Provider Demographics
NPI:1154766186
Name:KELLY, STEPHANIE ALBERS (RN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALBERS
Last Name:KELLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 LEEDS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-6861
Mailing Address - Country:US
Mailing Address - Phone:843-529-3150
Mailing Address - Fax:843-720-3142
Practice Address - Street 1:2685 LEEDS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-6861
Practice Address - Country:US
Practice Address - Phone:843-529-3150
Practice Address - Fax:843-720-3142
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81452374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician