Provider Demographics
NPI:1902047467
Name:KELLY, KAREN A (CM, FACNM, LMT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:A
Last Name:KELLY
Suffix:
Gender:F
Credentials:CM, FACNM, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 FAIRFAX DR
Mailing Address - Street 2:APT 1201
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-4442
Mailing Address - Country:US
Mailing Address - Phone:845-641-0563
Mailing Address - Fax:
Practice Address - Street 1:7010 GIRARD ST
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5013
Practice Address - Country:US
Practice Address - Phone:845-641-0563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017741225700000X
NY01544367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist