Provider Demographics
NPI:1467593830
Name:KELLEY, ROSEMARY EILEEN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:EILEEN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-4706
Mailing Address - Country:US
Mailing Address - Phone:315-783-7875
Mailing Address - Fax:
Practice Address - Street 1:100 S JAMES ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-4758
Practice Address - Country:US
Practice Address - Phone:919-587-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MK0830201OtherDEA NUMBER