Basic Information
| Provider Information | |||||||||
| NPI: | 1639436371 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACHARYA | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | SALTER | ||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | SALTER | ||||||||
| OtherFirstName: | KELLY | ||||||||
| OtherMiddleName: | HOLT | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2301 ERWIN RD | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196843491 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2301 ERWIN RD | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196843491 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2012 | ||||||||
| LastUpdateDate: | 06/30/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | NC | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.