Provider Demographics
NPI:1376254292
Name:FOUST, KELLY (PJLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:FOUST
Suffix:
Gender:F
Credentials:PJLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:STALEY
Mailing Address - State:NC
Mailing Address - Zip Code:27355-0036
Mailing Address - Country:US
Mailing Address - Phone:336-522-9317
Mailing Address - Fax:
Practice Address - Street 1:2606 OLIVERS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:STALEY
Practice Address - State:NC
Practice Address - Zip Code:27355-8251
Practice Address - Country:US
Practice Address - Phone:336-522-9317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy