Individual
KELLY MARIE DE GROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
901 E 4TH ST STE D, CHARLOTTE, NC 28204-2622
(866) 434-3255
Mailing address
901 E 4TH ST STE D, CHARLOTTE, NC 28204-2622
(866) 434-3255
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5015315
NC
Other
Enumeration date
02/25/2021
Last updated
05/22/2023
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