MEDICARE: KELLY MARIE MARTIN FNP-C

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	363LF0000X	Family Nurse Practitioner	0024195281	VA

General Provider Information

NPI Number	:	1588533657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MARIE MARTIN FNP-C

Provider Business Mailing Address
First Line	:	1442 GRAND OAK LN
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-5944
Country	:	US
Telephone Number	:	484-639-1925
Fax Number	:

Provider Business Practice Location Address
First Line	:	1904 MOODY RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-3134
Country	:	US
Telephone Number	:	484-639-1925
Fax Number	:

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

Provider Enumeration Date	:	11/05/2025
Last Update Date	:	01/06/2026

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