Individual
KELLI ANN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
101 HOLBROOK ST, DANVILLE, VA 24541-1759
(434) 792-7765
Mailing address
101 HOLBROOK ST, DANVILLE, VA 24541-1759
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024184388
VA
Other
Enumeration date
05/25/2022
Last updated
05/25/2022
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