Healthcare Provider Details

I. General information

NPI: 1922716042
Provider Name (Legal Business Name): KELLEY FLOWERS-FRAZIER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WADSWORTH DR
NORTH CHESTERFIELD VA
23236-4510
US

IV. Provider business mailing address

15506 WINDING ASH DR
CHESTERFIELD VA
23832-2639
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-8206
  • Fax: 804-497-5469
Mailing address:
  • Phone: 804-297-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110009348
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: