Individual
KELITA BOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
239 ROBESON ST, FAYETTEVILLE, NC 28301-5511
(910) 485-0555
Mailing address
PO BOX 53438, FAYETTEVILLE, NC 28305-3438
(910) 485-0555
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5015172
NC
363LF0000X
Family Nurse Practitioner
RN254240
GA
Other
Enumeration date
01/31/2019
Last updated
10/13/2021
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