Individual
MRS. KELSEY A FANTINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
817 VOLVO PKWY, CHESAPEAKE, VA 23320-2855
(757) 668-4630
Mailing address
817 VOLVO PKWY, CHESAPEAKE, VA 23320-2855
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110006774
VA
Other
Enumeration date
03/28/2019
Last updated
10/19/2022
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