Provider Demographics
NPI:1316563273
Name:PIERCE, KELLY NOEL
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:NOEL
Last Name:PIERCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 BOLLING AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-1349
Mailing Address - Country:US
Mailing Address - Phone:757-615-5439
Mailing Address - Fax:
Practice Address - Street 1:107 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1719
Practice Address - Country:US
Practice Address - Phone:757-776-3088
Practice Address - Fax:757-612-4499
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052064562251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics