Provider Demographics
NPI:1407615537
Name:BUELL, KELLI LEE
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:LEE
Last Name:BUELL
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 1:1240 MAGNOLIA VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9464
Mailing Address - Country:US
Mailing Address - Phone:910-599-2230
Mailing Address - Fax:
Practice Address - Street 1:1240 MAGNOLIA VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-9464
Practice Address - Country:US
Practice Address - Phone:910-599-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician