Individual
KELLY SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
21035 SYCOLIN ROAD, SUITE 180, ASHBURN, VA 20147-4311
(703) 783-5673
(703) 297-3919
Mailing address
224D CORNWALL STREET, NW, SUITE 403, LEESBURG, VA 20176-2704
(703) 737-6001
(703) 443-8346
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024186610
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639870652
—
VA
05
—
30017597090001
—
VA
Enumeration date
03/16/2023
Last updated
03/06/2024
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