Healthcare Provider Details

I. General information

NPI: 1295213528
Provider Name (Legal Business Name): KELLY STELLING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY COLLINS RN

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

1105 ANTIETAM CT
VIRGINIA BEACH VA
23454-2404
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-8031
  • Fax:
Mailing address:
  • Phone: 973-216-2580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0001275021
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: