Provider Demographics
NPI:1154161669
Name:HARRUP, KELBY LEWIS (PA-C)
Entity type:Individual
Prefix:
First Name:KELBY
Middle Name:LEWIS
Last Name:HARRUP
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 1:15617 PINOPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:BOYKINS
Mailing Address - State:VA
Mailing Address - Zip Code:23827-2043
Mailing Address - Country:US
Mailing Address - Phone:757-653-1412
Mailing Address - Fax:
Practice Address - Street 1:120 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-8161
Practice Address - Country:US
Practice Address - Phone:252-332-3548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant