Provider Demographics
NPI:1588724769
Name:SPAID, KELLY ANN (NP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:SPAID
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0344
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-6937
Practice Address - Street 1:500 SHEPHERD ST
Practice Address - Street 2:SUITE 500
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1633
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:336-716-6937
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5004026363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000703Medicaid
NC7000703Medicaid