Healthcare Provider Details

I. General information

NPI: 1467789495
Provider Name (Legal Business Name): KELLY F USSERY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST DEPARTMENT OF NEUROLOGY
RICHMOND VA
23298-5051
US

IV. Provider business mailing address

10140 CENTURION PKWY N
JACKSONVILLE FL
32256-0532
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-0442
  • Fax: 804-827-0941
Mailing address:
  • Phone: 904-697-4127
  • Fax: 904-697-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024170974
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: