Healthcare Provider Details

I. General information

NPI: 1801866454
Provider Name (Legal Business Name): KELLY SUE ROTHE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 S MAIN ST
BURNSVILLE NC
28714-2929
US

IV. Provider business mailing address

PO BOX 1240
BURNSVILLE NC
28714-1240
US

V. Phone/Fax

Practice location:
  • Phone: 828-678-9352
  • Fax: 828-682-7866
Mailing address:
  • Phone: 828-678-9352
  • Fax: 828-682-7866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200301048
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: