Individual
DR. JENNY LEE KELTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2730 A PROSPERITY AVENUE, FAIRFAX, VA 22031-2238
(703) 289-1410
(703) 289-1420
Mailing address
2730 B PROSPERITY AVENUE, FAIRFAX, VA 22031-2238
(703) 289-1400
(703) 289-1414
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
0101236840
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010087309
—
VA
05
—
0101037762
—
VA
05
—
010103789
—
VA
05
—
010103797
—
VA
Enumeration date
04/26/2006
Last updated
12/05/2007
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