Individual
MRS. KELLEY BRYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
14121 PARKE LONG CT, CHANTILLY, VA 20151-1647
(904) 521-4629
Mailing address
14121 PARKE LONG CT, CHANTILLY, VA 20151-1647
(904) 521-4629
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0002088968
VA
Other
Enumeration date
05/23/2017
Last updated
05/23/2017
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