Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 9583 | NC |
NPI | 1013930445 |
---|---|
Provider Name | Dr. Kellie Paxton |
First Address | Mooresville, NC 28117-7610 |
Second Address | Mooresville, NC 28117-7610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 18/11/2013 |