Individual
KELLY ELISE RUPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15 KILLDEER LN, DAYTON, VA 22821-9745
(540) 879-4300
Mailing address
15 KILLDEER LN, DAYTON, VA 22821-9745
(540) 879-4300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110006777
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/30/2019
Last updated
07/21/2021
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