Provider Demographics
NPI:1992404636
Name:NOVOTNEY, KELLY ANN (FNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:NOVOTNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:HODGSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:507 CHESOPEIAN TRL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7740
Mailing Address - Country:US
Mailing Address - Phone:773-680-6423
Mailing Address - Fax:
Practice Address - Street 1:699 WALNUT ST STE 400
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-3962
Practice Address - Country:US
Practice Address - Phone:188-759-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM73124363LF0000X
DCNP500015362363LF0000X
WY51998363LF0000X
VA0024186645363LF0000X
FLAPRN11032496363LF0000X
IL209027322363LF0000X
COC-RXN.0101519-C-NP363LF0000X
MDAC006813363LP2300X
IAA173617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024186645OtherVIRGINIA BOARD OF NURSING