Individual
KELLEY ANNETTE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1750 KERNERSVILLE MEDICAL PKWY, KERNERSVILLE, NC 27284-7146
(336) 564-4866
(336) 277-6815
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 564-4866
(336) 277-6815
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
DO.1175
AL
208M00000X
Hospitalist Physician
Primary
2012-00585
NC
Other
Enumeration date
07/16/2009
Last updated
05/23/2023
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