Provider Demographics
NPI:1417735333
Name:GILROY, KELLEY LYNN (NP-C)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:LYNN
Last Name:GILROY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KNOTBREAK RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5414
Mailing Address - Country:US
Mailing Address - Phone:540-444-5670
Mailing Address - Fax:
Practice Address - Street 1:100 KNOTBREAK RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5414
Practice Address - Country:US
Practice Address - Phone:540-444-5670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF311340363LA2200X
VA0024189963363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health