Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | KELLYJ2 | NY |
NPI | 1588618102 |
---|---|
Provider Name | Dr. Joann Caryl Kelly |
First Address | Chantilly, VA 20151-2228 |
Second Address | Chantilly, VA 20151-2228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/07/2007 |