Individual
KELLY ASHLEY BOARDMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
19415 DEERFIELD AVE, SUITE 213, LEESBURG, VA 20176-8452
(703) 729-9220
(703) 858-3529
Mailing address
2623 PURITAN CT, HERNDON, VA 20171-2439
(404) 326-2826
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110004747
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821492067
—
VA
05
—
30016805880001
—
VA
Enumeration date
10/17/2014
Last updated
03/06/2024
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