Healthcare Provider Details

I. General information

NPI: 1306678990
Provider Name (Legal Business Name): KELLY PATRICE DOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 EMPIRE CT
FREDERICKSBURG VA
22408-1949
US

IV. Provider business mailing address

10514 ABBERLY VILLAGE LN APT 450
FREDERICKSBURG VA
22407-2723
US

V. Phone/Fax

Practice location:
  • Phone: 540-371-0079
  • Fax:
Mailing address:
  • Phone: 678-472-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024190984
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: