Individual
KERI CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
19455 DEERFIELD AVE STE 311, LANSDOWNE, VA 20176-8102
(703) 723-9751
(703) 723-9752
Mailing address
19455 DEERFIELD AVE STE 311, LANSDOWNE, VA 20176-8102
(703) 723-9751
(703) 723-9752
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0110006290
VA
Other
Enumeration date
07/17/2018
Last updated
07/17/2018
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