Individual
KEIDRA MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
314 SIGNAL HILL DR, STATESVILLE, NC 28625-4357
(704) 450-9104
Mailing address
510 S MEETING ST, STATESVILLE, NC 28677-6108
(704) 450-9104
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
C89143
NC
174400000X
Specialist
Primary
CT2780
NC
Other
Enumeration date
04/27/2026
Last updated
04/27/2026
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