Provider Demographics
NPI:1699245936
Name:KELLEMS GERIATRIC HEALTHCARE
Entity type:Organization
Organization Name:KELLEMS GERIATRIC HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:KELLEMS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,NP-C
Authorized Official - Phone:804-432-4113
Mailing Address - Street 1:13700 N GAYTON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7017
Mailing Address - Country:US
Mailing Address - Phone:804-432-4113
Mailing Address - Fax:804-213-9783
Practice Address - Street 1:8715 BRAYS FORK DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3693
Practice Address - Country:US
Practice Address - Phone:804-432-4113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty