Individual provider Active NPI

KC Kelley, DO

  • Primary Care Clinic/Center
  • Lynchburg, VA
National Provider Identifier
1073207064
Registry record updated May 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
0102210148 Issued in VA
Practice address
2323 Memorial Ave Ste 10
Lynchburg, VA 24501-2652
Phone
(143) 420-0615
NPI assigned
Jun 5, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 18, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0116037899 VA
Primary Care Clinic/Center 261QP2300X 0102210148 VA Primary
Student in an Organized Health Care Education/Training Program 390200000X 0116037899 VA

Addresses

Primary practice location

2323 Memorial Ave Ste 10
Lynchburg, VA 24501-2652

Mailing address

16890 Forest Rd
Forest, VA 24551-4059
Phone (434) 200-7210

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230717000741 VA Order and Referring Only - Family PracticePractitioner - Family Practice 9133589674

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Liberty Univ College of Osteopathic Medicine, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

140 Vista Centre Dr
FL 2
Forest, VA 24551-3965

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
0102210148VAMDPrimary Care Clinic/Center
0116037899VAMDStudent in an Organized Health Care Education/Training Program

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1685923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779062400000",
    "number": "1073207064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16890 FOREST RD",
            "city": "FOREST",
            "state": "VA",
            "postal_code": "245514059",
            "telephone_number": "434-200-7210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 MEMORIAL AVE STE 10",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245012652",
            "telephone_number": "143-420-0615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "KC",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-05",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0116037899",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "VA",
            "license": "0102210148",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "0116037899",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynchburg, VA

Sources for this page

Verify at the official NPI Registry.