Provider Demographics
NPI:1811536048
Name:SWEATT, KELLY HAMILTON (PA-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:HAMILTON
Last Name:SWEATT
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 1:190 COURTLAND DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-1489
Mailing Address - Country:US
Mailing Address - Phone:864-906-6516
Mailing Address - Fax:
Practice Address - Street 1:1991 FORDHAM DR STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3774
Practice Address - Country:US
Practice Address - Phone:910-423-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant