Wallace, Kelly Elizabeth

Wallace, Kelly Elizabeth is an sole proprietor health care provider with primary practice located at 200 Medical Park Blvd , Petersburg VA 23805-9274. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Wallace, Kelly Elizabeth can be contacted via phone (804) 765-5000.

Contact Information

Primary practice address
200 Medical Park Blvd Petersburg VA 23805-9274
Phone: (804) 765-5000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 0024183547 Virginia

Profile Details

NPI number 1417609694
LBN Legal business name Wallace, Kelly Elizabeth
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 19th, 2022
Last updated Jan 27th, 2022 - about 4 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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