Provider Demographics
NPI:1073036802
Name:NOVICKI, KELSEY PARRISH (PA-C)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:PARRISH
Last Name:NOVICKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 SMITH GRADY RD
Mailing Address - Street 2:
Mailing Address - City:SEVEN SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28578-9503
Mailing Address - Country:US
Mailing Address - Phone:252-286-4889
Mailing Address - Fax:
Practice Address - Street 1:417 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349-8801
Practice Address - Country:US
Practice Address - Phone:910-296-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07421363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant