Healthcare Provider Details

I. General information

NPI: 1609732957
Provider Name (Legal Business Name): KELLY JENNIFER MOLINA CAMPOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16614 TELESCOPE LN
DUMFRIES VA
22026-2193
US

IV. Provider business mailing address

16614 TELESCOPE LN
DUMFRIES VA
22026-2193
US

V. Phone/Fax

Practice location:
  • Phone: 571-969-0322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0024195340
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: