Provider Demographics
NPI:1972242840
Name:QUAILE, KELSEY MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE
Last Name:QUAILE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 SLATE DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-2867
Mailing Address - Country:US
Mailing Address - Phone:336-354-8827
Mailing Address - Fax:
Practice Address - Street 1:3804 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9134
Practice Address - Country:US
Practice Address - Phone:336-524-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-12246363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant