Provider Demographics
NPI:1417655895
Name:LIGUORI, KELLY MARIE (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:LIGUORI
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5743 GATEKEEPER LN
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-5596
Mailing Address - Country:US
Mailing Address - Phone:609-790-9266
Mailing Address - Fax:
Practice Address - Street 1:1021 MOREHEAD MEDICAL DR STE 6200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2994
Practice Address - Country:US
Practice Address - Phone:980-442-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC5020709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program