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General NPI Number Information
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NPI Number | 1508669052
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Entity Type | Organization
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Legal Business Name | IMPERIAL BLUE MEDICAL LLC
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 8296 SEMINOLE TRL
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City | RUCKERSVILLE
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State | VA
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Zip | 22968-3492
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Country | US
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Telephone | 434-326-7531
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Fax |
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Provider Business Mailing Address
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Address Line | 8296 SEMINOLE TRL
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City | RUCKERSVILLE
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State | VA
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Zip | 22968-3492
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Country | US
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Telephone | 434-481-4322
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELSEY MORRIS
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Credential | FNPC
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Telephone | 434-326-7531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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