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General NPI Number Information
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NPI Number | 1447082474
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Entity Type | Individual
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Provider Name | KELSEY MARIE COLLETTI PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 3320 WAKE FOREST RD STE 430
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City | RALEIGH
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State | NC
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Zip | 27609-7300
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Country | US
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Telephone | 919-256-1511
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Fax |
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Provider Business Mailing Address
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Address Line | 500 SAINT ALBANS DR UNIT 554
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City | RALEIGH
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State | NC
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Zip | 27609-6681
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Country | US
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Telephone | 703-789-6524
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 0010-15241
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-15241
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License Number State | NC
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