Basic Information
| Provider Information | |||||||||
| NPI: | 1003480039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE | ||||||||
| Address2: | CAMPUS BOX #7525, BRINKHOUS-BULLITT BUILDING | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199664676 | ||||||||
| FaxNumber: | 9199666718 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MANNING DR | ||||||||
| Address2: | DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275144220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849747836 | ||||||||
| FaxNumber: | 9849740290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2021 | ||||||||
| LastUpdateDate: | 05/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | RTL21-0106 | NC | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.