Kelly Elizabeth Wallace, NP
NPI #1417609694 in Petersburg, Virginia
Provider Information
- NPI Number
- 1417609694
- Entity Type
- Individual
- Name
- Kelly Elizabeth Wallace, NP
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Nurse Practitioner
- Credential
- NP
- Enumeration Date
- Jan 19, 2022
- Last Updated
- Jan 27, 2022
Practice Location
- Address
- 200 MEDICAL PARK BLVD
- City
- Petersburg
- State
- Virginia
- ZIP Code
- 23805-9274
- Phone
- (804) 765-5000
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner |
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