Individual
KELLY BRILLANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
606 E 12TH ST, WASHINGTON, NC 27889-3409
(252) 946-1573
(252) 946-1316
Mailing address
606 E 12TH ST, WASHINGTON, NC 27889-3409
(252) 946-1573
(252) 946-1316
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-01820
NC MEDICAL BOARD
NC
Enumeration date
09/18/2009
Last updated
08/16/2012
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