Healthcare Provider Details

I. General information

NPI: 1114068418
Provider Name (Legal Business Name): JANE H KELMAN LPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 HAW RIDGE RD
SUMMERFIELD NC
27358-9374
US

IV. Provider business mailing address

7300 HAW RIDGE RD
SUMMERFIELD NC
27358-9374
US

V. Phone/Fax

Practice location:
  • Phone: 336-644-1051
  • Fax: 336-644-6660
Mailing address:
  • Phone: 336-644-1051
  • Fax: 336-644-6660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1169
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: