Kelly Russell Burris, NP
Individual provider Active NPI Family Nurse Practitioner · Fries, VA
NPI 1194011007 · NPPES record last updated Oct 11, 2025
Key facts
- NPI
- 1194011007
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 0021469439 (VA)
- Practice address
- 109 Carrol Dr
Fries, VA 24330-4532 - Phone
- (888) 908-4788
- Fax
- (276) 398-3331
- NPI assigned
- Jun 20, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 14
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Tri Area Community Health
Practice addresses (Care Compare)
14558 Danville Pike
Laurel Fork, VA 24352-3982
Phone (276) 398-2292
Hospital & facility affiliations
- Access Home Health Care and Rehabilitation
- Twin County Regional Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110802000695 | VA | Practitioner - Nurse Practitioner | 8426227729 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5007750 | NC | MD | Nurse Practitioner |
| 0021469439 | VA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri Area Community Health | Current |
Accepting new patients | |
| Emergency Coverage Services, PC | Nurse Practitioner | Current |
Accepting new patients |
| Tri Area Community Health | Current |
Accepting new patients | |
| Emergency Physicians of Southern Virginia LLP | Nurse Practitioner | Current |
Accepting new patients |
| Tri Area Community Health | Past | Accepting new patients | |
| Tri Area Community Health | Past | Accepting new patients |
Locations
3700 S Main St
Blacksburg, VA 24060
Phone (540) 951-1111
109 Carrol Dr
Fries, VA 24330
Phone (276) 744-3660
200 Hospital Dr
Galax, VA 24333
Phone (276) 236-6011
200 Maroon Tide Dr
Galax, VA 24333
Phone (888) 819-4284
14558 Danville Pike
#9
Laurel Fork, VA 24352
Phone (540) 398-2292
14558 Danville Pike
Laurel Fork, VA 24352
Phone (276) 398-1200
6801 Governor Gc Peery Hwy
Richlands, VA 24641
Phone (276) 523-8600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 5007750 | NC | |
| Nurse Practitioner | 363L00000X | 5007750 | NC | |
| Family Nurse Practitioner | 363LF0000X | 0021469439 | VA | Yes |
| Nurse Practitioner | 363L00000X | 0024169439 | VA |
Addresses
Primary practice location
109 Carrol Dr
Fries, VA 24330-4532
Mailing address
PO Box 9
Laurel Fork, VA 24352-0009
Phone (276) 398-1200
Other practice location 1
200 Maroon Tide Dr
Galax, VA 24333-4238
Phone (888) 908-4788
Other practice location 2
14558 Danville Pike
Laurel Fork, VA 24352-3982
Phone (276) 398-2292
Other names
- Kelly Michele Russell
Other providers in Fries, VA
- Dawn Bullins
- Michael A Cobler
- Joy K Creed
- Fries Community Health Care Inc
- Fries Community Health Care Inc
- Fries Family Care Center PC
All providers in Fries, VA · Family Nurse Practitioner in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.