Provider Demographics
NPI:1306132881
Name:MORALES, KELLY NICOLE (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:NICOLE
Last Name:MORALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:NICOLE
Other - Last Name:LAMBRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4920 OHEAR AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-5093
Mailing Address - Country:US
Mailing Address - Phone:574-238-9266
Mailing Address - Fax:843-856-3788
Practice Address - Street 1:4920 OHEAR AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-5093
Practice Address - Country:US
Practice Address - Phone:843-856-3784
Practice Address - Fax:843-856-3788
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC61216207Q00000X
KS7695207Q00000X
CODR.0054489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine