Individual
MRS. KELLY MITZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
401 CARPENTER RD, FORT MYER, VA 22211-1009
(703) 966-7935
Mailing address
401 CARPENTER RD, FORT MYER, VA 22211-1009
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110002992
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073584777
NPI
—
Enumeration date
01/30/2006
Last updated
07/30/2024
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