Individual
KELLI LYN KAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10628 PARK RD, CHARLOTTE, NC 28210-8407
(703) 667-1000
Mailing address
1055 N 500 W, ATTN CREDENTIALING, PROVO, UT 84604
(801) 354-8225
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-06770
NC
363A00000X
Physician Assistant
Primary
12298680-1206
UT
Other
Enumeration date
09/28/2016
Last updated
12/10/2021
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