Provider Demographics
NPI:1104120393
Name:KELLY, PARVEEN (CPM, LM)
Entity type:Individual
Prefix:MRS
First Name:PARVEEN
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 TANALIAN FALLS LN
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-2176
Mailing Address - Country:US
Mailing Address - Phone:703-945-1591
Mailing Address - Fax:
Practice Address - Street 1:12300 TANALIAN FALLS LN
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-2176
Practice Address - Country:US
Practice Address - Phone:703-505-5499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-01
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000059176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife