Individual
KYLEANA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
5350 CLEARBROOK VILLAGE LN, ROANOKE, VA 24014-6606
(540) 204-9477
(540) 774-2128
Mailing address
5671 HOLLINS RD APT 3, ROANOKE, VA 24019-5004
(540) 589-7942
(540) 774-2128
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1101003349
VA
Other
Enumeration date
05/19/2023
Last updated
05/19/2023
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