Carroll, Kathleen Kelly

Carroll, Kathleen Kelly is an individual health care provider with primary practice located at 805 Westmont Dr , Fayetteville NC 28305-4555. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Carroll, Kathleen Kelly can be contacted via phone (910) 484-4061.

Contact Information

Primary practice address
805 Westmont Dr Fayetteville NC 28305-4555
Phone: (910) 484-4061
Fax: (910) 485-4069
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 6455 North Carolina
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 200401185 North Carolina

Profile Details

NPI number 1376674010
LBN Legal business name Carroll, Kathleen Kelly
Credentials M.S., M.A., APRN-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 7th, 2007
Last updated May 22nd, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376674010 NPPES
North Carolina MEDICAID 6113055

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