Healthcare Provider Details

I. General information

NPI: 1346475076
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 05/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 HIOAKS RD
RICHMOND VA
23225-4029
US

IV. Provider business mailing address

1001 HIOAKS RD
RICHMOND VA
23225-4029
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-7139
  • Fax: 804-323-0153
Mailing address:
  • Phone: 804-320-7139
  • Fax: 804-323-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number0017139437
License Number StateVA

VIII. Authorized Official

Name: MS. KELLY ELMORE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 804-320-7139