Individual
KAYLYN MARIE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
5372B OLD VIRGINIA STREET, SALUDA, VA 23149
(804) 758-5250
Mailing address
PO BOX 1223, MATHEWS, VA 23109-1223
(804) 384-2008
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0001287908
VA
163WE0003X
Emergency Registered Nurse
0001287908
VA
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
0001287908
VA
171M00000X
Case Manager/Care Coordinator
—
—
2080P0006X
Developmental - Behavioral Pediatrics Physician
0001287908
VA
222Q00000X
Developmental Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001287908
RN MULTISTATE COMPACT LICENSE
VA
Enumeration date
03/23/2022
Last updated
03/23/2022
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