Healthcare Provider Details

I. General information

NPI: 1669976114
Provider Name (Legal Business Name): KELLI LYNN FOX DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E BROAD ST
RICHMOND VA
23298-5025
US

IV. Provider business mailing address

PO BOX 980204
RICHMOND VA
23298-0204
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-4905
  • Fax: 804-828-7710
Mailing address:
  • Phone: 804-628-4905
  • Fax: 804-828-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number0102207244
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.014970
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0102207244
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0102207244
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: