Healthcare Provider Details

I. General information

NPI: 1487815056
Provider Name (Legal Business Name): KELLY ROBINSON PHILLIPS MPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY ELIZABETH ROBINSON MPAS, PA-C

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WENDOVER AVE STE 111
GREENSBORO NC
27401-1209
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-7840
  • Fax: 336-832-3285
Mailing address:
  • Phone: 336-852-7530
  • Fax: 336-774-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-02044
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-02044
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA01364
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: