MEDICARE: DR. KELLY MARIE VAN FOSSEN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	2009-00374	NC

General Provider Information

NPI Number	:	1396957429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY MARIE VAN FOSSEN D.O.

Provider Business Mailing Address
First Line	:	4140 FERNCREEK DRIVE
Second Line	:	SUITE 601
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-2569
Country	:	US
Telephone Number	:	910-485-3880
Fax Number	:	910-485-5341

Provider Business Practice Location Address
First Line	:	4140 FERNCREEK DRIVE
Second Line	:	SUITE 601
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-2569
Country	:	US
Telephone Number	:	910-485-3880
Fax Number	:	910-485-5341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2025

Similar Medicare Providers

1225997067 — MEGHAN EDENFIELD DAVIS LMBT
Practice Location Address:

4140 FERNCREEK DR STE 702
FAYETTEVILLE, NC
28314-2569

Practice Phone: 828-269-6235
Practice Fax: 828-269-6235

1043318611 — DENA MARIE POZEG PA-C
Practice Location Address:

4140 FERNCREEK DRIVE , SUITE 601
FAYETTEVILLE, NC
28314-2569

Practice Phone: 910-485-3880
Practice Fax: 910-485-5341

1740389188 — IJEOMA ACHOLONU EJEH M.D.
Practice Location Address:

4140 FERNCREEK DRIVE , SUITE 601
FAYETTEVILLE, NC
28314-2569

Practice Phone: 910-485-3880
Practice Fax: 910-485-5341

1841514817 — DR. OVIE EFEURHOBO APPRESAI M.D.
Practice Location Address:

4140 FERNCREEK DR STE 601
FAYETTEVILLE, NC
28314-2569

Practice Phone: 910-485-3880
Practice Fax:

1275844177 — DR. YANA MIKHAYLOV
Practice Location Address:

4140 FERNCREEK DR STE 601
FAYETTEVILLE, NC
28314-2569

Practice Phone: 734-904-2211
Practice Fax:

1548510969 — CUMBERLAND COUNTY HOSPITAL SYSTEM INC
Practice Location Address:

4140 FERNCREEK DR STE 601
FAYETTEVILLE, NC
28314-2569

Practice Phone: 910-485-3880
Practice Fax: 910-615-9618

Directions to “ DR. KELLY MARIE VAN FOSSEN D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.