Individual
KELLY ELIZABETH BOUTELLE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
N2198, CB7010, CHAPEL HILL, NC 27599-7010
(919) 966-4873
(919) 966-5136
Mailing address
N2198, CB7010, CHAPEL HILL, NC 27599-7010
(919) 966-4873
(919) 966-5136
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
NC
Other
Enumeration date
04/14/2026
Last updated
04/14/2026
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