Provider Demographics
NPI:1346416948
Name:SCHOFIELD, KELLY ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ALLAN
Last Name:SCHOFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1603 W NC HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5511
Mailing Address - Country:US
Mailing Address - Phone:919-275-2845
Mailing Address - Fax:833-740-3415
Practice Address - Street 1:1603 W NC HIGHWAY 54
Practice Address - Street 2:DURHAM
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5511
Practice Address - Country:US
Practice Address - Phone:919-443-2341
Practice Address - Fax:919-869-1678
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-021762084P0800X
NCNC2012-021762084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1609288034Medicaid