Provider Demographics
NPI:1053348623
Name:FARMER, KELLY M (ST)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:FARMER
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3803 COMPUTER DR # B
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6541
Mailing Address - Country:US
Mailing Address - Phone:919-870-9591
Mailing Address - Fax:919-846-4705
Practice Address - Street 1:3803 COMPUTER DR # B
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6541
Practice Address - Country:US
Practice Address - Phone:919-870-9591
Practice Address - Fax:919-846-4705
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211076Medicaid
NC7412139Medicaid