Provider Demographics
NPI:1578850947
Name:WARNOCK, KELLY LYNN (FNP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNN
Last Name:WARNOCK
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 1:103 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BETHUNE
Mailing Address - State:SC
Mailing Address - Zip Code:29009
Mailing Address - Country:US
Mailing Address - Phone:843-334-6551
Mailing Address - Fax:803-438-4391
Practice Address - Street 1:1165 HIGHWAY 1 S
Practice Address - Street 2:SUITE 300
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-8966
Practice Address - Country:US
Practice Address - Phone:803-438-0867
Practice Address - Fax:803-438-4391
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF4476363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily