Provider Demographics
NPI:1316066079
Name:O'HARA, KELLIE HARNEY (FNP)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:HARNEY
Last Name:O'HARA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 N NC 16 BUSINESS HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-3002
Mailing Address - Country:US
Mailing Address - Phone:704-489-3440
Mailing Address - Fax:888-815-0892
Practice Address - Street 1:275 N NC 16 BUSINESS HWY STE 104
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-3002
Practice Address - Country:US
Practice Address - Phone:704-489-3440
Practice Address - Fax:888-815-0892
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5002520363L00000X
NC0050-02520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1316066079Medicaid
NCNCM704BMedicare PIN