Individual
KEELY REICHEL GERRALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
10650 PARK RD, CHARLOTTE, NC 28210-8538
(704) 667-3840
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-10207
NC
Other
Enumeration date
05/04/2016
Last updated
07/17/2024
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