Provider Demographics
NPI:1558709584
Name:KELLEMS, JEREMY GLEN (NP)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:GLEN
Last Name:KELLEMS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 N GAYTON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7017
Mailing Address - Country:US
Mailing Address - Phone:804-432-4133
Mailing Address - Fax:804-213-9783
Practice Address - Street 1:3600 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-1930
Practice Address - Country:US
Practice Address - Phone:804-672-8725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001209239163W00000X
VA0017141048363LF0000X
VA0024170856363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse