Provider Demographics
NPI:1750679429
Name:KELLY, CATHY (NP)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9950 COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:VA
Mailing Address - Zip Code:23030-3434
Mailing Address - Country:US
Mailing Address - Phone:804-829-6600
Mailing Address - Fax:804-829-6182
Practice Address - Street 1:9950 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:VA
Practice Address - Zip Code:23030-3434
Practice Address - Country:US
Practice Address - Phone:804-829-6600
Practice Address - Fax:804-829-6182
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA00024169432363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily