Kelly, Timothy L

Kelly, Timothy L is an individual health care provider with primary practice located at 2720 Sunset Blvd , West Columbia SC 29169. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Kelly, Timothy L can be contacted via phone (803) 935-8292.

Contact Information

Primary practice address
2720 Sunset Blvd West Columbia SC 29169
Phone: (803) 935-8292
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 219 South Carolina

Profile Details

NPI number 1770567836
LBN Legal business name Kelly, Timothy L
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 2nd, 2005
Last updated Sep 15th, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770567836 NPPES
South Carolina MEDICAID AN0930

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