Provider Demographics
NPI:1205626207
Name:CRAIGHEAD, KELLY M (RN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:CRAIGHEAD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 DIANE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1472
Mailing Address - Country:US
Mailing Address - Phone:304-997-0143
Mailing Address - Fax:
Practice Address - Street 1:1106 DIANE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-1472
Practice Address - Country:US
Practice Address - Phone:304-997-0143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001201574163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health