Provider Demographics
NPI:1760638472
Name:JAMES, KELLY P (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:P
Last Name:JAMES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 E ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5870
Mailing Address - Country:US
Mailing Address - Phone:252-558-9893
Mailing Address - Fax:252-565-0171
Practice Address - Street 1:313 BLUEBEECH LN
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-0526
Practice Address - Country:US
Practice Address - Phone:252-558-9893
Practice Address - Fax:252-565-0171
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5291235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413398Medicaid
NC157UEOtherBCBSNC
NC7413398Medicaid