Provider Demographics
NPI:1942298757
Name:KELLY, DARREN BRENT (MD)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:BRENT
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28138-0215
Mailing Address - Country:US
Mailing Address - Phone:704-209-0418
Mailing Address - Fax:704-209-0420
Practice Address - Street 1:11055 HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:NC
Practice Address - Zip Code:28138-9792
Practice Address - Country:US
Practice Address - Phone:704-209-0418
Practice Address - Fax:704-209-0420
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97-01003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine