Provider Demographics
NPI:1144476318
Name:MINSLEY, KELLY NEAL (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:NEAL
Last Name:MINSLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 18563
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27619-8563
Mailing Address - Country:US
Mailing Address - Phone:919-782-1806
Mailing Address - Fax:919-782-4756
Practice Address - Street 1:3521 HAWORTH DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7244
Practice Address - Country:US
Practice Address - Phone:919-782-1806
Practice Address - Fax:919-782-4756
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105227207R00000X
NC2011-01728207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001866100Medicaid
FLP00759769OtherRAILROAD MEDICARE PROVIDER NUMBER
FLCH967ZMedicare PIN