Healthcare Provider Details

I. General information

NPI: 1073291340
Provider Name (Legal Business Name): KAYTE KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 OWEN DR
FAYETTEVILLE NC
28304-3424
US

IV. Provider business mailing address

1638 OWEN DR DEPT OF
FAYETTEVILLE NC
28304-3424
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-8000
  • Fax: 910-321-6265
Mailing address:
  • Phone: 910-615-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5018493
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5018493
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2023018702
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: