Kelley Marie Mayberry, RDH

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

0402207854 Issued in VA

Practice address

4038 Thomas Nelson Hwy
Arrington, VA 22922-2302

Phone

(434) 263-6310

NPI assigned

Aug 23, 2019

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1566518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566518400000",
    "number": "1114574100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4038 THOMAS NELSON HWY",
            "city": "ARRINGTON",
            "state": "VA",
            "postal_code": "229222302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4038 THOMAS NELSON HWY",
            "city": "ARRINGTON",
            "state": "VA",
            "postal_code": "229222302",
            "telephone_number": "434-263-6310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYBERRY",
        "first_name": "KELLEY",
        "middle_name": "MARIE",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-23",
        "last_updated": "2019-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "VA",
            "license": "0402207854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kmayberry@brmedical.com",
            "affiliation": "N",
            "address_1": "4038 Thomas Nelson Hwy",
            "city": "Arrington",
            "state": "VA",
            "country_code": "US",
            "postal_code": "229222302",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gerald W. Dewitt, M.D.
• Danae Consuelo Guerra, PA
• Rachel Faye Harris, DNP, FNP-BC
• Aniessa Holland
• Tracy Lee Lopez, DMD
• Elizabeth Reagan Michaels, PA-C
• Anita Neville
• Janet J Ngai, PT
• Benjamin Elliott Nissley, FNP-C
• Dustin B Orange, PHARMD

• All providers in Arrington, VA
• Public Health Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.