Healthcare Provider Details

I. General information

NPI: 1801211651
Provider Name (Legal Business Name): KELLY HART FINNEGAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY H FINNEGAN PA

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 DAVIS ST STE 1
BLACKSBURG VA
24060-7004
US

IV. Provider business mailing address

817 DAVIS ST STE 1
BLACKSBURG VA
24060-7004
US

V. Phone/Fax

Practice location:
  • Phone: 540-552-3670
  • Fax: 540-552-7585
Mailing address:
  • Phone: 540-552-3670
  • Fax: 540-552-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110004890
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: