Individual
KATHLEEN KELLER SIEGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
8450 PARK RD, CHARLOTTE, NC 28210-5801
(980) 308-0143
(980) 308-0142
Mailing address
PO BOX 601843, CHARLOTTE, NC 28260-1843
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-06188
NC
Other
Enumeration date
03/08/2016
Last updated
05/12/2022
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