Healthcare Provider Details

I. General information

NPI: 1831461599
Provider Name (Legal Business Name): KELLY J REECE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE
ROANOKE VA
24014-1838
US

IV. Provider business mailing address

1320 THOMAS LN
BLACKSBURG VA
24060-9306
US

V. Phone/Fax

Practice location:
  • Phone: 540-266-6331
  • Fax:
Mailing address:
  • Phone: 908-246-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110003773
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: