Provider Demographics
NPI:1801211651
Name:FINNEGAN, KELLY HART (PA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:HART
Last Name:FINNEGAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:H
Other - Last Name:FINNEGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:817 DAVIS ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7004
Mailing Address - Country:US
Mailing Address - Phone:540-552-3670
Mailing Address - Fax:540-552-7585
Practice Address - Street 1:817 DAVIS ST STE 1
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7004
Practice Address - Country:US
Practice Address - Phone:540-552-3670
Practice Address - Fax:540-552-7585
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004890363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant