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NPI Code Detail

MEDICARE: LYNN C KELLY PA

MEDICARE: LYNN C KELLY PA
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
1363A00000XPhysician Assistant0110001615VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
176055POTHERVAOPTIMA

General Provider Information

NPI Number : 1811993942
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNN C KELLY PA
Provider Business Mailing Address
First Line : 5900 LAKE WRIGHT DR
Second Line : SUITE 300
City : NORFOLK
State : VA
Zip : 23502-1871
Country : US
Telephone Number : 757-213-5700
Fax Number : 757-213-5701
Provider Business Practice Location Address
First Line : 1051 LOFTIS
Second Line : SUITE 100
City : NEWPORT NEWS
State : VA
Zip : 23606-4250
Country : US
Telephone Number : 757-873-9400
Fax Number : 757-873-9420
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 04/28/2008

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Directions to “ LYNN C KELLY PA” Practice Location

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