MEDICARE: SARAH M KIELY 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	363LF0000X	Family Nurse Practitioner	0024170836	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1639513245	OTHER	VA	TRICARE PRIME
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639513245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH M KIELY NP

Provider Business Mailing Address
First Line	:	PO BOX 1460
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22402-1460
Country	:	US
Telephone Number	:	540-785-7810
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 SPOTSYLVANIA PKWY
Second Line	:	SUITE 204
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-9435
Country	:	US
Telephone Number	:	540-785-7810
Fax Number	:	540-834-5411

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

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	10/23/2014

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