Healthcare Provider Details

I. General information

NPI: 1952274763
Provider Name (Legal Business Name): KELLY BJERKNESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SECOND AVE
HALETHORPE MD
21227-3203
US

IV. Provider business mailing address

401 SECOND AVE
HALETHORPE MD
21227-3203
US

V. Phone/Fax

Practice location:
  • Phone: 757-389-2831
  • Fax:
Mailing address:
  • Phone: 757-389-2831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number0001264458
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: