Provider Demographics
NPI:1689742280
Name:MORGAN, KELLY ANN (MS, APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MS, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 GLYNDON ST NE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-3539
Mailing Address - Country:US
Mailing Address - Phone:703-319-9696
Mailing Address - Fax:
Practice Address - Street 1:489 CARLISLE DR STE B
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4897
Practice Address - Country:US
Practice Address - Phone:703-758-4461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000334101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health