Healthcare Provider Details

I. General information

NPI: 1376887497
Provider Name (Legal Business Name): MRS. KELSEY R ALFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 HIRST RD
PURCELLVILLE VA
20132-6198
US

IV. Provider business mailing address

2730-D PROSPERITY AVENUE
FAIRFAX VA
22031
US

V. Phone/Fax

Practice location:
  • Phone: 703-226-2290
  • Fax: 703-289-1420
Mailing address:
  • Phone: 703-289-1400
  • Fax: 703-289-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024170474
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: