Individual
KELLY RUSSELL BURRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
109 CARROL DR, FRIES, VA 24330-4532
(888) 908-4788
(276) 398-3331
Mailing address
PO BOX 9, LAUREL FORK, VA 24352-0009
(276) 398-1200
(336) 789-0856
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024169439
VA
363L00000X
Nurse Practitioner
5007750
NC
363LF0000X
Family Nurse Practitioner
Primary
0021469439
VA
363LF0000X
Family Nurse Practitioner
5007750
NC
Other
Enumeration date
06/20/2011
Last updated
10/11/2025
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