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General NPI Number Information
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NPI Number | 1740130418
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Entity Type | Individual
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Provider Name | KELLYE RAJA TRUESDALE DNP, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 500 SHEPHERD ST
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1633
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Country | US
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Telephone | 336-716-4039
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Fax |
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Provider Business Mailing Address
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Address Line | 11107 PAGEBROOK LN
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City | CHARLOTTE
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State | NC
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Zip | 28214-7176
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Country | US
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Telephone |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 5023868
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License Number State | NC
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