Provider Demographics
NPI:1194298448
Name:ROBERTSON, KELLY CHRISTINA (MSN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CHRISTINA
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:CHRISTINA
Other - Last Name:DONALDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3801 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2503
Mailing Address - Country:US
Mailing Address - Phone:703-383-8130
Mailing Address - Fax:703-383-7350
Practice Address - Street 1:3801 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2503
Practice Address - Country:US
Practice Address - Phone:703-383-8130
Practice Address - Fax:703-383-7350
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000205462163W00000X
VA0024180381363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse