Individual
MRS. KELSEY NORKETT TRULL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1070 VINEHAVEN DR NE, CONCORD, NC 28025-2438
(704) 783-1840
Mailing address
4228 SAINT AUDREY PL, CHARLOTTE, NC 28269-8394
(704) 773-1488
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508279043
—
NC
01
—
188GM
BCBS OF NORTH CAROLINA
NC
Enumeration date
06/03/2014
Last updated
10/09/2014
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