Individual
KELLEY ELIZABETH HAVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2160 HERBERT CT, GREENVILLE, NC 27834-3736
(252) 744-3850
(252) 744-3894
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2017-01465
NC
207V00000X
Obstetrics & Gynecology Physician
Primary
2017-01465
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851739221
—
NC
01
—
19R2P
BCBS OF NC
NC
01
—
NCZ066A
MEDICARE
NC
Enumeration date
06/07/2013
Last updated
12/01/2023
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