Provider Demographics
NPI:1285109819
Name:KELLY, TIERRA LASHONDA (MSN FNP-C)
Entity type:Individual
Prefix:
First Name:TIERRA
Middle Name:LASHONDA
Last Name:KELLY
Suffix:
Gender:F
Credentials:MSN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 WINSTON CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-5141
Mailing Address - Country:US
Mailing Address - Phone:804-458-8583
Mailing Address - Fax:
Practice Address - Street 1:1012 WINSTON CHURCHILL DR
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-5141
Practice Address - Country:US
Practice Address - Phone:804-458-8583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175609363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily