Individual
KELLY LEE MCCLEARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 231-6132
(919) 231-6276
Mailing address
PO BOX 603949, CHARLOTTE, NC 28260-3949
(919) 350-0351
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-11698
NC
363AM0700X
Medical Physician Assistant
Primary
0010-11698
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-11698
NC LICENSE
NC
05
—
1598427643
—
NC
Enumeration date
10/06/2021
Last updated
03/23/2022
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