Provider Demographics
NPI:1750052155
Name:KELLEY, KIMBERLY MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:101 CABARRUS AVE E STE 200
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-3781
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4705 UNIVERSITY DR BLDG 700
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3489
Practice Address - Country:US
Practice Address - Phone:919-237-1337
Practice Address - Fax:919-237-1625
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCF06210571207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine