Individual
DR. KELLY ANNE TRUESDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
7033 SAINT ANDREWS RD, COLUMBIA, SC 29212-1179
(803) 732-0963
(803) 732-1406
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
(803) 732-0963
(803) 732-1406
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
83843
SC
207Q00000X
Family Medicine Physician
8612
SD
207Q00000X
Family Medicine Physician
OP60524953
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2044716
—
WA
Enumeration date
07/01/2011
Last updated
01/15/2024
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