Individual
JEREMY GLEN KELLEMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
3600 MOUNTAIN RD, GLEN ALLEN, VA 23060-1930
(804) 672-8725
Mailing address
13700 N GAYTON RD, RICHMOND, VA 23233-7017
(804) 432-4133
(804) 213-9783
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001209239
VA
363LF0000X
Family Nurse Practitioner
0017141048
VA
363LF0000X
Family Nurse Practitioner
Primary
0024170856
VA
Other
Enumeration date
06/12/2013
Last updated
07/16/2020
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