Healthcare Provider Details

I. General information

NPI: 1356461990
Provider Name (Legal Business Name): ALISHA B. KELLY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MEDICAL PKWY FL 2
CHESAPEAKE VA
23320-0302
US

IV. Provider business mailing address

667 KINGSBOROUGH SQ STE 101
CHESAPEAKE VA
23320-4999
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-4047
  • Fax: 757-410-0339
Mailing address:
  • Phone: 757-842-4481
  • Fax: 757-312-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberUP006842C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: