Individual
KALLIE TESORIERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
6035 FAIRVIEW RD, CHARLOTTE, NC 28210-3256
(704) 295-3000
(704) 295-3326
Mailing address
6035 FAIRVIEW RD, CHARLOTTE, NC 28210-3256
(704) 295-3000
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
12579
NC
231H00000X
Audiologist
4074
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285157669
—
NC
01
—
1458532
WELLCARE OF SC
SC
01
—
19R9S
BCBSNC
NC
01
—
5647765
AETNA
—
01
—
8780919
CIGNA
—
01
—
Q57402A
MEDICARE-NC
NC
05
—
SAN141
—
SC
Enumeration date
07/18/2017
Last updated
12/12/2024
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