Healthcare Provider Details

I. General information

NPI: 1861574303
Provider Name (Legal Business Name): KELLIE WALTER FURIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 FIDELITY ST
CARRBORO NC
27510-2002
US

IV. Provider business mailing address

127 FIDELITY ST
CARRBORO NC
27510-2002
US

V. Phone/Fax

Practice location:
  • Phone: 919-933-8381
  • Fax: 919-933-6623
Mailing address:
  • Phone: 919-933-8381
  • Fax: 919-933-6623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5002294
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: