Healthcare Provider Details

I. General information

NPI: 1396577680
Provider Name (Legal Business Name): KELLY JONES SCHMIDT PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 MEDICAL PARK BLVD
PETERSBURG VA
23805-9337
US

IV. Provider business mailing address

269 MEDICAL PARK BLVD
PETERSBURG VA
23805-9337
US

V. Phone/Fax

Practice location:
  • Phone: 804-861-0700
  • Fax:
Mailing address:
  • Phone: 804-861-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024190992
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: