MEDICARE: KELSEY HARMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	0024176348	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0024176348	OTHER	VA	NURSE PRACTITIONER LICENSE NUMBER

General Provider Information

NPI Number	:	1467938845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY HARMAN

Provider Business Mailing Address
First Line	:	6515 W JUNALUSKA DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-2219
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7401 BEAUFONT SPRINGS DR STE 100
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-5504
Country	:	US
Telephone Number	:	804-203-2350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2018
Last Update Date	:	07/18/2018

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Directions to “ KELSEY HARMAN ” Practice Location

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