MEDICARE: KELLEY FLOWERS-FRAZIER PA-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	363A00000X	Physician Assistant	0110009348	VA

General Provider Information

NPI Number	:	1922716042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY FLOWERS-FRAZIER PA-C

Provider Business Mailing Address
First Line	:	15506 WINDING ASH DR
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-2639
Country	:	US
Telephone Number	:	804-297-2018
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 WADSWORTH DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-4510
Country	:	US
Telephone Number	:	804-285-8206
Fax Number	:	804-497-5469

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

Provider Enumeration Date	:	11/08/2022
Last Update Date	:	12/12/2025

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