Individual
KELLY CASSEDY MASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2645 MERIDIAN PKWY STE 323, DURHAM, NC 27713-4232
(984) 227-8902
Mailing address
176 BLUEBERRY LN, RAEFORD, NC 28376-8328
(404) 247-3168
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
124340
GA
363LF0000X
Family Nurse Practitioner
124340
GA
363LF0000X
Family Nurse Practitioner
Primary
5008052
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005599973A
—
GA
Enumeration date
08/01/2007
Last updated
03/17/2022
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