Provider Demographics
NPI:1447901129
Name:CARSWELL KELLY, NATASHA (RN)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:CARSWELL 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 1:100 POSTMASTER DR UNIT 2423
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-2821
Mailing Address - Country:US
Mailing Address - Phone:678-365-1611
Mailing Address - Fax:
Practice Address - Street 1:1006 ARBOR WAY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8715
Practice Address - Country:US
Practice Address - Phone:678-365-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN174115163WC1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health