Individual
KELLY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1237 SHIREHALL PARK LN, WAKE FOREST, NC 27587-0601
(919) 667-3714
Mailing address
1237 SHIREHALL PARK LN, WAKE FOREST, NC 27587-0601
(919) 667-3714
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001006672
NC
Other
Enumeration date
08/29/2016
Last updated
08/29/2016
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