Provider Demographics
NPI:1942370861
Name:HYDE, KELLY STAMBAUGH (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:STAMBAUGH
Last Name:HYDE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:963 LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:MARBLE
Mailing Address - State:NC
Mailing Address - Zip Code:28905-6801
Mailing Address - Country:US
Mailing Address - Phone:828-837-8131
Mailing Address - Fax:828-837-7687
Practice Address - Street 1:4048 E US HIGHWAY 64 ALT
Practice Address - Street 2:PHYSICIAN OFFICE BUILDING SUITE 1
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-6968
Practice Address - Country:US
Practice Address - Phone:828-837-8131
Practice Address - Fax:828-837-7687
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC101776363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC101776OtherLICENSE