Provider Demographics
NPI:1982338976
Name:STARETS, KELLYANNE CHERRY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLYANNE
Middle Name:CHERRY
Last Name:STARETS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELLYANNE
Other - Middle Name:FAITH
Other - Last Name:CHERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2720 W ARLINGTON BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4110
Mailing Address - Country:US
Mailing Address - Phone:845-803-9142
Mailing Address - Fax:
Practice Address - Street 1:2720 W ARLINGTON BLVD APT 101
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4110
Practice Address - Country:US
Practice Address - Phone:845-803-9142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
390200000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program