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Individual
MR. TIMOTHY P KELLEY
Active
Individual
MR. TIMOTHY P KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001000651
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
085001277
—
IL
05
—
1679654057
—
NC
05
—
8101237
—
NC
Enumeration date
10/18/2006
Last updated
09/09/2020
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