Healthcare Provider Details

I. General information

NPI: 1790689065
Provider Name (Legal Business Name): ALAINA J KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4365 STARKEY RD
ROANOKE VA
24018-0610
US

IV. Provider business mailing address

12276 SAN JOSE BLVD STE 508
JACKSONVILLE FL
32223-8618
US

V. Phone/Fax

Practice location:
  • Phone: 540-613-8339
  • Fax: 540-527-5093
Mailing address:
  • Phone: 904-886-3228
  • Fax: 904-485-8876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-452838
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: