Individual
KELLIE DUVALL SOUTHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1188 YADKINVILLE RD, MOCKSVILLE, NC 27028-2037
(336) 716-7435
(336) 702-9277
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 713-0947
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5011023
NC
363LF0000X
Family Nurse Practitioner
5011023
NC
Other
Enumeration date
09/26/2018
Last updated
12/05/2023
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