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NPI Code Detail

MEDICARE: JESSICA KELLY

MEDICARE: JESSICA KELLY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1235400540
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA KELLY
Provider Business Mailing Address
First Line : 4828 HARBOR OAKS WAY
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23455-1944
Country : US
Telephone Number : 757-450-3421
Fax Number :
Provider Business Practice Location Address
First Line : 4828 HARBOR OAKS WAY
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23455-1944
Country : US
Telephone Number : 305-846-9807
Fax Number : 305-846-9711
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2012
Last Update Date : 07/21/2022

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