Healthcare Provider Details

I. General information

NPI: 1992615553
Provider Name (Legal Business Name): MEARA KELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 STILLMAN PKWY
GLEN ALLEN VA
23060-4167
US

IV. Provider business mailing address

9270 MARL RIDGE LN
MECHANICSVILLE VA
23116-2445
US

V. Phone/Fax

Practice location:
  • Phone: 804-613-5532
  • Fax:
Mailing address:
  • Phone: 757-812-3023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: