Individual
MRS. KELLY MAINES SQUIRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
23 SUNNYBROOK RD, RALEIGH, NC 27610-1855
(919) 235-6435
Mailing address
2920 HIGHWOODS BLVD, RALEIGH, NC 27604-0010
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
246271
NC
363LP0200X
Pediatric Nurse Practitioner
Primary
5010058
NC
Other
Enumeration date
11/14/2017
Last updated
04/13/2021
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