Individual
ANDREA MALUTA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2015 RANDOLPH RD STE 208, CHARLOTTE, NC 28207-1241
(704) 377-4009
Mailing address
13808 PROFESSIONAL CENTER DR STE 302, HUNTERSVILLE, NC 28078-7948
(704) 377-4009
(704) 602-4381
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001004126
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689956641
—
NC
05
—
2531PA
—
SC
Enumeration date
09/15/2011
Last updated
11/20/2019
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