Provider Demographics
NPI:1356764690
Name:TE, KALIYANN (PA-C)
Entity type:Individual
Prefix:
First Name:KALIYANN
Middle Name:
Last Name:TE
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 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-716-0238
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-3736
Practice Address - Country:US
Practice Address - Phone:336-713-4500
Practice Address - Fax:336-713-4501
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04770363A00000X
NC001004770363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13347760OtherPHCS-MULTIPLAN
NC1356764690Medicaid
NC1458919OtherCOVENTRY OF THE CAROLINAS
NCFH4001665OtherFIRST CAROLINA CARE
NC250511OtherMEDCOST
NC4293725OtherCOVENTRY NATIONAL - COVENTRY PPO
NC1356764690OtherHUMANA
NC1458919OtherWELLPATH
NC1356764690OtherHEALTHNET FEDERAL SERVICES
NC4952804OtherAETNA
NC185TDOtherBCBS OF NC
NC1356764690OtherHEALTHSMART
NC1356764690OtherDOCTORS DIRECT
NC3819841OtherUNITED HEALTHCARE
NC6877441OtherCIGNA-GREATWEST