Provider Demographics
NPI:1861410086
Name:MAUPIN, KELLY J (NP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:MAUPIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:PRITCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:155 RIVERBEND DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8607
Mailing Address - Country:US
Mailing Address - Phone:434-295-0184
Mailing Address - Fax:434-295-2463
Practice Address - Street 1:8220 MEADOWBRIDGE RD STE 203
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2339
Practice Address - Country:US
Practice Address - Phone:804-764-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00793026Medicare PIN
VA014338A36Medicare PIN
P70586Medicare UPIN