Boardman, Kelly Ashley

Boardman, Kelly Ashley is an sole proprietor health care provider with primary practice located at 19415 Deerfield Ave Suite 213, Leesburg VA 20176-8452. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Boardman, Kelly Ashley can be contacted via phone (703) 729-9220.

Contact Information

Primary practice address
19415 Deerfield Ave Suite 213 Leesburg VA 20176-8452
Phone: (703) 729-9220
Fax: (703) 858-3529
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 0110004747 Virginia

Profile Details

NPI number 1821492067
LBN Legal business name Boardman, Kelly Ashley
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 17th, 2014
Last updated Mar 6th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821492067 NPPES
Virginia MEDICAID 1821492067
Virginia MEDICAID 30016805880001

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