1770564767 NPI number — MRS. CHRISTINA MARIE KELLEIGH MPT

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770564767 NPI number — MRS. CHRISTINA MARIE KELLEIGH MPT

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KELLEIGH

Provider First Name:

CHRISTINA

Provider Middle Name:

MARIE

Provider Name Prefix Text:

MRS.

Provider Name Suffix Text:

Provider Credential Text:

MPT

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

PUTNEY

Provider Other First Name:

CHRISTINA

Provider Other Middle Name:

MARIE

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

MPT

Provider Other Last Name Type Code:

1

NPI Number:

1770564767

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/21/2026

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 412313

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BOSTON

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

02241-2313

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

3901 WRIGHTSVILLE AVE STE 120

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WILMINGTON

Provider Business Practice Location Address State Name:

NC

Provider Business Practice Location Address Postal Code:

28403-6256

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

910-679-8385

Provider Business Practice Location Address Fax Number:

910-679-8387

Provider Enumeration Date:

11/08/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225100000X , with the licence number:  11549 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 2251P0200X , with the licence number: 11549 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 225000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 7384345 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 4980093 . This is a "VIRGINIA PREMIER HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 35062 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 11230494 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
• Identifier: 223302 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 870146 . This is a "UNITED HEALTHCARE/OPTUM HEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 436752 . This is a "ANTHEM BLUE CROSS" identifier . This identifiers is of the category "OTHER".
• Identifier: 9116460 . This is a "MEDICAID DME" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 0682U . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 6400313 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".