MEDICARE: KELLYE RAJA TRUESDALE DNP, FNP-C

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	207V00000X	Obstetrics & Gynecology Physician	5023868	NC

General Provider Information

NPI Number	:	1740130418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLYE RAJA TRUESDALE DNP, FNP-C

Provider Business Mailing Address
First Line	:	11107 PAGEBROOK LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-7176
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 SHEPHERD ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1633
Country	:	US
Telephone Number	:	336-716-4039
Fax Number	:

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

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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