Provider Demographics
NPI:1780834721
Name:OSBORNE, KELLY E (PA)
Entity Type:Individual
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First Name:KELLY
Middle Name:E
Last Name:OSBORNE
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1331 N ELM ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6302
Mailing Address - Country:US
Mailing Address - Phone:336-274-9617
Mailing Address - Fax:336-482-2177
Practice Address - Street 1:1002 N CHURCH ST STE 302
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1449
Practice Address - Country:US
Practice Address - Phone:336-387-8100
Practice Address - Fax:336-387-8205
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2019-03-11
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Provider Licenses
StateLicense IDTaxonomies
NC0010-01537363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1780834721Medicaid