Kelley, Timothy P

Kelley, Timothy P is an individual health care provider with primary practice located at 202 Williamson Rd Ste 100 , Mooresville NC 28117-7610. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Kelley, Timothy P can be contacted via phone (704) 799-7811.

Contact Information

Primary practice address
202 Williamson Rd Ste 100 Mooresville NC 28117-7610
Phone: (704) 799-7811
Fax: (704) 799-7812
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 001000651 North Carolina

Profile Details

NPI number 1679654057
LBN Legal business name Kelley, Timothy P
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 18th, 2006
Last updated Sep 9th, 2020 - about 4 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 1679654057 NPPES
North Carolina MEDICAID 1679654057
North Carolina MEDICAID 8101237
North Carolina MEDICAID 085001277

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