Individual
WILLIAM FERRIS KELLY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
317 WESTERN BLVD, JACKSONVILLE, NC 28546-6338
(910) 577-2345
Mailing address
107 WEBB ST, SWANSBORO, NC 28584-9668
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0034643
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0760C
BLUE CROSS GROUP
NC
01
—
48216
BLUE SHIELD NC
NC
01
—
562014989001
TRICARE GROUP
NC
05
—
6907604
—
NC
05
—
8948216
—
NC
Enumeration date
03/14/2007
Last updated
07/09/2007
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