Individual
KELLY LEE MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MMS
Contact information
Practice address
1860 TOWN CENTER DR STE 130, RESTON, VA 20190-5898
(703) 689-2050
(703) 689-2080
Mailing address
1860 TOWN CENTER DR STE 130, RESTON, VA 20190-5898
(703) 689-2050
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110005101
VA
Other
Enumeration date
11/12/2015
Last updated
03/04/2025
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