Provider Demographics
NPI:1700143070
Name:RIERSON, KELLY
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:RIERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:RIERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SW
Mailing Address - Street 1:23 WHISPER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WHISPERING PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28327-9399
Mailing Address - Country:US
Mailing Address - Phone:910-528-2046
Mailing Address - Fax:
Practice Address - Street 1:2908 CONCERTO CT
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-3615
Practice Address - Country:US
Practice Address - Phone:910-528-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist