Provider Demographics
NPI:1013360940
Name:DODD, KELLYN PATRICIA (APRN)
Entity Type:Individual
Prefix:
First Name:KELLYN
Middle Name:PATRICIA
Last Name:DODD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELLYN
Other - Middle Name:PATRICIA
Other - Last Name:FREED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:6400 ARLINGTON BLVD SUITE 920
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042
Mailing Address - Country:US
Mailing Address - Phone:703-241-2664
Mailing Address - Fax:703-241-5559
Practice Address - Street 1:6400 ARLINGTON BLVD SUITE 920
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042
Practice Address - Country:US
Practice Address - Phone:703-241-2664
Practice Address - Fax:703-241-5559
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH068318-23363LF0000X
VA0024176021363LF0000X
VA24176021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily