Healthcare Provider Details

I. General information

NPI: 1649558826
Provider Name (Legal Business Name): HOLLY KRISTEN KELLETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 EVELYN BYRD AVE
HARRISONBURG VA
22801
US

IV. Provider business mailing address

1871 EVELYN BYRD AVE
HARRISONBURG VA
22801-3487
US

V. Phone/Fax

Practice location:
  • Phone: 540-564-5800
  • Fax: 540-564-5801
Mailing address:
  • Phone: 540-564-5800
  • Fax: 540-564-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024169578
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169578
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: