Healthcare Provider Details

I. General information

NPI: 1154373579
Provider Name (Legal Business Name): LAURA HERRING KELLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MS. LAURA LEE HERRING

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRAIL SUITE 103
RALEIGH NC
27607
US

IV. Provider business mailing address

4414 LAKE BOONE TRAIL SUITE 103
RALEIGH NC
27607
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-0266
  • Fax: 919-571-9314
Mailing address:
  • Phone: 919-787-0266
  • Fax: 919-571-9314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9701433
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: