Healthcare Provider Details

I. General information

NPI: 1356776967
Provider Name (Legal Business Name): PATRICK J KELLEY L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 DRESSER CT
RALEIGH NC
27609-7323
US

IV. Provider business mailing address

607 CHURCHILL DR
CHAPEL HILL NC
27517-2506
US

V. Phone/Fax

Practice location:
  • Phone: 919-792-3940
  • Fax:
Mailing address:
  • Phone: 919-698-9431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number679
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: