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Individual

JARED ROBERT KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
612 MOCKSVILLE AVE, SALISBURY, NC 28144-2732
(818) 391-7794
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 210-5061
(704) 210-5337

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
0010-08856
NC
2084P0804X
Child & Adolescent Psychiatry Physician
0010-08856
NC
2084P0805X
Geriatric Psychiatry Physician
0010-08856
NC
363A00000X
Physician Assistant
Primary
0010-08856
NC

Other

Enumeration date
03/20/2019
Last updated
10/26/2020
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