Healthcare Provider Details

I. General information

NPI: 1992743991
Provider Name (Legal Business Name): KELLY ADAIR VIRGIL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 ADMIRAL DR STE 105A
HIGH POINT NC
27265-1554
US

IV. Provider business mailing address

3755 ADMIRAL DR STE 105A
HIGH POINT NC
27265-1554
US

V. Phone/Fax

Practice location:
  • Phone: 336-673-5097
  • Fax: 336-203-3644
Mailing address:
  • Phone: 336-673-5097
  • Fax: 336-203-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number900281
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: