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General NPI Number Information
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NPI Number | 1932247079
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Entity Type | Individual
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Provider Name | R. BRUCE KELLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 04/02/2009
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Provider Practice Location Address
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Address Line | 932 OLD HWY 70 WEST
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City | BLACK MOUNTAIN
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State | NC
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Zip | 28711
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Country | US
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Telephone | 828-669-3218
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Fax | 828-669-3229
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Provider Business Mailing Address
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Address Line | 21 HILLENDALE RD
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City | ASHEVILLE
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State | NC
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Zip | 28805-1749
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Country | US
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Telephone | 828-259-6912
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 25339
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License Number State | NC
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