Provider Demographics
NPI:1659520930
Name:KELLEY, PATICIA ANNETTE (RN)
Entity Type:Individual
Prefix:MS
First Name:PATICIA
Middle Name:ANNETTE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 GREEN FORD LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-6219
Mailing Address - Country:US
Mailing Address - Phone:336-251-2019
Mailing Address - Fax:
Practice Address - Street 1:1905 GREEN FORD LN
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-6219
Practice Address - Country:US
Practice Address - Phone:336-251-2019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC180625163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse