Individual
KELLY V BYRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3000 COLISEUM DR, SUITE 104, HAMPTON, VA 23666-5963
(757) 827-9400
(757) 827-9320
Mailing address
6350 CENTER DR STE 200, NORFOLK, VA 23502-4107
(757) 905-5558
(757) 213-5701
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002989
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1942441191
OPTIMA
VA
05
—
1942441191
—
VA
01
—
P00724783
RAILROAD MEDICARE
VA
Enumeration date
03/18/2009
Last updated
05/16/2022
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