Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 9601607 | NC |
NPI | 1023000676 |
---|---|
Provider Name | Dr. Kellie A Faulk |
First Address | Charlotte, NC 28260-0447 |
Second Address | Winston Salem, NC 27103-3104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 08/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
891003P | (05) | NC |
G38519 | (02) | NC |