Provider Demographics
NPI:1306211156
Name:KURTH, KELLEY PRIVETT (RN, MSN, AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:PRIVETT
Last Name:KURTH
Suffix:
Gender:F
Credentials:RN, MSN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 BLUFFTON RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-5798
Mailing Address - Country:US
Mailing Address - Phone:601-259-7009
Mailing Address - Fax:
Practice Address - Street 1:9920 KINCEY AVE STE 140
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-2401
Practice Address - Country:US
Practice Address - Phone:704-820-4197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008906363L00000X
COAPN.0992043-NP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner