Provider Demographics
NPI:1285865188
Name:RICHERT, KELLY CUTSHALL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CUTSHALL
Last Name:RICHERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2426 FOLSOM LN
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6313
Mailing Address - Country:US
Mailing Address - Phone:828-308-0815
Mailing Address - Fax:
Practice Address - Street 1:6729 FALLS OF NEUSE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5287
Practice Address - Country:US
Practice Address - Phone:919-844-4344
Practice Address - Fax:919-844-3244
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-01586363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant