Healthcare Provider Details

I. General information

NPI: 1922824390
Provider Name (Legal Business Name): KALEAB BEKELE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 SIMONS RUN
LYNCHBURG VA
24502-8911
US

IV. Provider business mailing address

1155 SIMONS RUN
LYNCHBURG VA
24502-8911
US

V. Phone/Fax

Practice location:
  • Phone: 434-287-5300
  • Fax:
Mailing address:
  • Phone: 434-287-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024198578
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: