Provider Demographics
NPI:1922716042
Name:FLOWERS-FRAZIER, KELLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:FLOWERS-FRAZIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15506 WINDING ASH DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-2639
Mailing Address - Country:US
Mailing Address - Phone:804-297-2018
Mailing Address - Fax:
Practice Address - Street 1:13911 ST FRANCIS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3256
Practice Address - Country:US
Practice Address - Phone:804-423-9913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110009348363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty