MEDICARE: KELLIE ANNE CLIFTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5020399	NC

General Provider Information

NPI Number	:	1104663947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE ANNE CLIFTON

Provider Business Mailing Address
First Line	:	20 DUKE MEDICINE CIR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27710-2000
Country	:	US
Telephone Number	:	919-684-5301
Fax Number	:	919-661-1697

Provider Business Practice Location Address
First Line	:	20 DUKE MEDICINE CIRCLE
Second Line	:	CLINIC 3-1
City	:	DURHAM
State	:	NC
Zip	:	27710
Country	:	US
Telephone Number	:	919-684-5301
Fax Number	:	919-661-1697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	12/01/2025

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