Healthcare Provider Details

I. General information

NPI: 1588533657
Provider Name (Legal Business Name): KELLY MARIE MARTIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY M COGGINS FNP

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CROSSWAYS BLVD STE A
CHESAPEAKE VA
23320-2895
US

IV. Provider business mailing address

1442 GRAND OAK LN
WEST CHESTER PA
19380-5944
US

V. Phone/Fax

Practice location:
  • Phone: 757-282-4070
  • Fax: 757-440-3288
Mailing address:
  • Phone: 484-639-1925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024195281
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: