Healthcare Provider Details

I. General information

NPI: 1730519992
Provider Name (Legal Business Name): KELLY SWAIN ESPOSITO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 BARRETT DR STE 200
RALEIGH NC
27609-7172
US

IV. Provider business mailing address

3700 BARRETT DR STE 200
RALEIGH NC
27609-7172
US

V. Phone/Fax

Practice location:
  • Phone: 919-231-3966
  • Fax: 919-231-3912
Mailing address:
  • Phone: 919-231-3966
  • Fax: 919-231-3912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-04778
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: