Provider Demographics
NPI:1992743991
Name:VIRGIL, KELLY ADAIR (NP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ADAIR
Last Name:VIRGIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3755 ADMIRAL DR STE 105A
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1554
Mailing Address - Country:US
Mailing Address - Phone:336-673-5097
Mailing Address - Fax:336-203-3644
Practice Address - Street 1:3755 ADMIRAL DR STE 105A
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1554
Practice Address - Country:US
Practice Address - Phone:336-673-5097
Practice Address - Fax:336-203-3644
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND900281363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ65202Medicare UPIN
NC259246AMedicare ID - Type Unspecified