Provider Demographics
NPI:1396400602
Name:O'BRIEN, KELLY DAY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DAY
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 LATIMER RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5362
Mailing Address - Country:US
Mailing Address - Phone:919-274-4962
Mailing Address - Fax:
Practice Address - Street 1:4715 LATIMER RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5362
Practice Address - Country:US
Practice Address - Phone:919-274-4962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date: