Provider Demographics
NPI:1295185635
Name:CONNER, KELLY RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:RENEE
Last Name:CONNER
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:NEUROLOGY DEPT
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-4101
Mailing Address - Fax:336-716-9486
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:NEUROLOGY DEPT
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-4101
Practice Address - Fax:336-716-9486
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
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Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant