Healthcare Provider Details

I. General information

NPI: 1902047467
Provider Name (Legal Business Name): KAREN A KELLY CM, FACNM, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 GIRARD ST
MC LEAN VA
22101-5013
US

IV. Provider business mailing address

3444 FAIRFAX DR APT 1201
ARLINGTON VA
22201-4442
US

V. Phone/Fax

Practice location:
  • Phone: 845-641-0563
  • Fax:
Mailing address:
  • Phone: 845-641-0563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number017741
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number01544
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: