Individual
KELLEY JO BAJILLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5826 SAMET DR, HIGH POINT, NC 27265-3660
(336) 878-6540
(336) 878-6541
Mailing address
624 QUAKER LN, STE. 207C, HIGH POINT, NC 27262-3832
(336) 883-2500
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
182481
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437445962
—
VA
Enumeration date
06/23/2011
Last updated
10/04/2016
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