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General NPI Number Information
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NPI Number | 1073497632
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Entity Type | Individual
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Provider Name | KELLY FAULKNER APRN
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Gender | Female
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 8133 LEESBURG PIKE STE 600
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City | VIENNA
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State | VA
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Zip | 22182-2733
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Country | US
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Telephone | 855-479-4217
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Fax | 888-557-9724
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Provider Business Mailing Address
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Address Line | 4602 TOLLHOUSE LN
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City | LOUISVILLE
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State | KY
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Zip | 40241-1733
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Country | US
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Telephone | 502-595-7302
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4042938
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License Number State | KY
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