Individual
MISS KELLY LYNN CORNELISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, R.T. (R)
Contact information
Practice address
20 DUKE MEDICINE CIR # 2-2, DURHAM, NC 27710-2000
(919) 668-6688
Mailing address
20 DUKE MEDICINE CIR # 2-2, DURHAM, NC 27710-2000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-14464
NC
363A00000X
Physician Assistant
PA8440
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
MA
Other
Enumeration date
10/06/2020
Last updated
09/27/2024
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