Healthcare Provider Details

I. General information

NPI: 1013708544
Provider Name (Legal Business Name): KELLI BURNETT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MEDICAL CENTER CIR STE 103
FISHERSVILLE VA
22939-2273
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-245-7400
  • Fax: 540-245-7401
Mailing address:
  • Phone: 540-332-5168
  • Fax: 540-932-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011317
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: