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General NPI Number Information
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NPI Number | 1396008488
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Entity Type | Individual
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Provider Name | VALARIE DENISE KELLY RN
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Gender | Female
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 06/24/2012
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Provider Practice Location Address
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Address Line | 5639 LEWIS B PULLER HWY
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City | SHACKLEFORDS
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State | VA
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Zip | 23156-0023
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Country | US
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Telephone | 804-785-2096
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 23 5639 LEWIS B PULLER HWY
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City | SHACKLEFORDS
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State | VA
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Zip | 23156
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Country | US
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Telephone | 804-785-2096
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 001217444
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License Number State | VA
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