Provider Demographics
NPI:1801134275
Name:KELLY, KATHERINE MERCEDES (CNM)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MERCEDES
Last Name:KELLY
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:PO BOX 17030
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4065
Mailing Address - Country:US
Mailing Address - Phone:919-852-1053
Mailing Address - Fax:
Practice Address - Street 1:226 ASHVILLE AVE STE 120
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6660
Practice Address - Country:US
Practice Address - Phone:919-852-1053
Practice Address - Fax:919-233-9012
Is Sole Proprietor?:No
Enumeration Date:2013-01-19
Last Update Date:2018-02-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife