Basic Information
| Provider Information | |||||||||
| NPI: | 1750655023 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLEY | ||||||||
| FirstName: | VIRGINIA | ||||||||
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| Credential: | F.N.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 RESEARCH PL | ||||||||
| Address2: | |||||||||
| City: | NORTH CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018632454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784596737 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20 RESEARCH PL | ||||||||
| Address2: | |||||||||
| City: | NORTH CHELMSFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018632454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784596737 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2012 | ||||||||
| LastUpdateDate: | 10/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 826747 | CA | N | Nursing Service Providers | Registered Nurse | 163WG0000X | RN2270710 | MA | N | Nursing Service Providers | Registered Nurse | General Practice | 363LF0000X | 22404 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | RN2270710 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.