Provider Demographics
NPI:1578673349
Name:DRUMHELLER, KELLY W (NP C)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:W
Last Name:DRUMHELLER
Suffix:
Gender:F
Credentials:NP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1700
Mailing Address - Country:US
Mailing Address - Phone:229-242-6061
Mailing Address - Fax:229-242-6151
Practice Address - Street 1:117 W NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1700
Practice Address - Country:US
Practice Address - Phone:229-242-6061
Practice Address - Fax:229-242-6151
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN141047NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
F0605200OtherFAMILY NURSE PRACTIONER
GARN141047NPOtherLICENCE NUMBER
FL308955000Medicaid
GA181714338CMedicaid
F0605200OtherFAMILY NURSE PRACTIONER
GA50BBJWWMedicare ID - Type Unspecified
GA181714338CMedicaid
FL308955000Medicaid