Provider Demographics
NPI:1457020067
Name:KADLEC, LILY GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:GRACE
Last Name:KADLEC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:GRACE
Other - Last Name:PRIOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4320 SEMINARY RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1535
Mailing Address - Country:US
Mailing Address - Phone:703-504-3167
Mailing Address - Fax:703-504-3388
Practice Address - Street 1:4320 SEMINARY RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1535
Practice Address - Country:US
Practice Address - Phone:703-504-3167
Practice Address - Fax:703-504-3388
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2233363A00000X
VA0110008831363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant