Provider Demographics
NPI:1104151349
Name:FINK, KELLI LYNN
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:LYNN
Last Name:FINK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E BEVERLEY ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-4322
Mailing Address - Country:US
Mailing Address - Phone:540-885-4499
Mailing Address - Fax:
Practice Address - Street 1:15 E BEVERLEY ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4322
Practice Address - Country:US
Practice Address - Phone:540-885-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1201094812174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist