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NPI Code Detail

MEDICARE: KELLY ELIZABETH TRAWICK

MEDICARE: KELLY ELIZABETH TRAWICK
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
1390200000XStudent in an Organized Health Care Education/Training Program
2363A00000XPhysician Assistant0010-12421NC

General Provider Information

NPI Number : 1841949823
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY ELIZABETH TRAWICK
Provider Business Mailing Address
First Line : 620 DR CALVIN JONES HWY STE 212
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-3108
Country : US
Telephone Number : 919-761-5678
Fax Number :
Provider Business Practice Location Address
First Line : 620 DR CALVIN JONES HWY STE 212
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-3108
Country : US
Telephone Number : 919-761-5678
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2022
Last Update Date : 07/16/2024

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Directions to “ KELLY ELIZABETH TRAWICK ” Practice Location

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