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Polley Clinic of Dermatology & Dermatologic Surgery

Dermatopathology Physician in Wilson, NC · enumerated 2006 · authorized official Kelli Newman, Credentialing Specialist.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1104847714

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Registry record

Entity type Organization (Type 2)
Legal business name Polley Clinic of Dermatology & Dermatologic Surgery
Practice address 1806 Glendale Dr Sw, Wilson, NC, 27893
Fax (252) 243-1347
Enumeration date Jul 21, 2006
Last updated in NPPES Aug 4, 2021

Taxonomy & classification

207ND0900X Dermatopathology Physician Allopathic & Osteopathic Physicians · License 27881 (NC) Primary

Authorized official

Name Kelli Newman
Title Credentialing Specialist

Other identifiers

Identifier Type State Issuer
2222414 Other NC FIRST HEALTH
0296G Other NC BCBS OF NC
785505 Other NC UNITED HEALTH CARE
68327 Other NC ACCORDIA
7068303 Other NC CIGNA
7257619 Other NC AETNA
890296G Medicaid NC -
DE4848 Other NC RAIL ROAD MEDICARE
99494 Other NC MEDCOST

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What is the NPI number for Polley Clinic of Dermatology & Dermatologic Surgery?
The NPI for Polley Clinic of Dermatology & Dermatologic Surgery is 1104847714, a Type 2 (organization) record in the CMS NPPES registry.
Who is the authorized official for Polley Clinic of Dermatology & Dermatologic Surgery?
NPPES lists Kelli Newman (Credentialing Specialist) as the authorized official for this organization.

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2021-08-04.