Individual
MRS. COLLEEN DENISE KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11234 LEATHERWOOD DR, RESTON, VA 20191-4607
(703) 391-0758
(703) 391-0758
Mailing address
12255 FAIR LAKES PKWY, FAIRFAX, VA 22033-3952
(703) 934-5700
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110840732
VA
Other
Enumeration date
06/09/2006
Last updated
11/23/2010
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