Healthcare Provider Details

I. General information

NPI: 1891334041
Provider Name (Legal Business Name): KELSEY ANN FREY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2020
Last Update Date: 01/14/2023
Certification Date: 01/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 DUKE MEDICINE CIR
DURHAM NC
27710-7412
US

IV. Provider business mailing address

20 DUKE MEDICINE CIR
DURHAM NC
27710-2000
US

V. Phone/Fax

Practice location:
  • Phone: 919-668-5360
  • Fax: 919-684-5743
Mailing address:
  • Phone: 919-668-5360
  • Fax: 919-684-5743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number0010-09679
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-09679
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: