Provider Demographics
NPI:1942800370
Name:KELLY, MAGDALENE SARIEL (PA-C)
Entity type:Individual
Prefix:
First Name:MAGDALENE
Middle Name:SARIEL
Last Name:KELLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-9702
Mailing Address - Country:US
Mailing Address - Phone:717-440-0185
Mailing Address - Fax:
Practice Address - Street 1:1520 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7356
Practice Address - Country:US
Practice Address - Phone:910-662-8300
Practice Address - Fax:910-662-8361
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NC0010-14558363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant