Provider Demographics
NPI:1164068250
Name:MARTIC, KELLY ANN (NP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:MARTIC
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1000 BOULDERS PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5515
Mailing Address - Country:US
Mailing Address - Phone:804-320-4243
Mailing Address - Fax:804-622-0552
Practice Address - Street 1:13551 WATERFORD PL
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3929
Practice Address - Country:US
Practice Address - Phone:804-320-4243
Practice Address - Fax:804-622-0552
Is Sole Proprietor?:No
Enumeration Date:2019-11-23
Last Update Date:2024-08-12
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Provider Licenses
StateLicense IDTaxonomies
VA0024178186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily