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General NPI Number Information
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NPI Number | 1972242840
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Entity Type | Individual
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Provider Name | KELSEY MARIE QUAILE PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 3804 S CHURCH ST
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City | BURLINGTON
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State | NC
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Zip | 27215-9134
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Country | US
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Telephone | 336-524-0304
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Fax |
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Provider Business Mailing Address
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Address Line | 334 SLATE DR
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City | GIBSONVILLE
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State | NC
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Zip | 27249-2867
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Country | US
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Telephone | 336-354-8827
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-12246
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License Number State | NC
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