MEDICARE: KELLY JENNIFER MOLINA CAMPOS NP

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	207Q00000X	Family Medicine Physician	0024195340	VA

General Provider Information

NPI Number	:	1609732957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY JENNIFER MOLINA CAMPOS NP

Provider Business Mailing Address
First Line	:	16614 TELESCOPE LN
Second Line	:
City	:	DUMFRIES
State	:	VA
Zip	:	22026-2193
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 HOWLE AVE STE A
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-2449
Country	:	US
Telephone Number	:	833-225-3558
Fax Number	:

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

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	01/15/2026

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