Individual
KELLY D THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2296 OPITZ BLVD STE 230, WOODBRIDGE, VA 22191-3345
(703) 878-0924
(703) 878-1037
Mailing address
2296 OPITZ BLVD STE 230, WOODBRIDGE, VA 22191-3345
(703) 878-0924
(703) 878-1037
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110004519
VA
Other
Enumeration date
02/26/2014
Last updated
11/14/2019
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