Provider Demographics
NPI:1336739010
Name:KALIS, SCOTT (MSHS, NRP)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:KALIS
Suffix:
Gender:M
Credentials:MSHS, NRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 KINDLING HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3849
Mailing Address - Country:US
Mailing Address - Phone:757-418-1472
Mailing Address - Fax:757-430-3772
Practice Address - Street 1:UNITED STATES NAVY
Practice Address - Street 2:1510 GILBERT ST
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511
Practice Address - Country:US
Practice Address - Phone:757-435-1756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAE031981004146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic