Provider Demographics
NPI:1033315395
Name:BOOKOUT, KELLYE RABB (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLYE
Middle Name:RABB
Last Name:BOOKOUT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1119 HENDERSONVILLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1803
Mailing Address - Country:US
Mailing Address - Phone:828-274-6003
Mailing Address - Fax:828-274-6004
Practice Address - Street 1:1119 HENDERSONVILLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1803
Practice Address - Country:US
Practice Address - Phone:828-274-6003
Practice Address - Fax:828-274-6004
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00932363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8928939Medicaid