Individual
KELLY MARIE NORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
260 TOWNSHIP BLVD, STE 20, CAMILLUS, NY 13031-1678
(315) 708-0091
(315) 708-0194
Mailing address
260 TOWNSHIP BLVD, STE 20, CAMILLUS, NY 13031-1678
(315) 708-0091
(315) 708-0194
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
MA001686L
PA
363AM0700X
Medical Physician Assistant
Primary
OA002604
PA
Other
Enumeration date
11/06/2006
Last updated
08/29/2019
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