Nathaniel Kelley, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701010683 Issued in VA

Practice address

7460 Central Business Park Dr
Norfolk, VA 23513-2818

Phone

(540) 421-5001

NPI assigned

Jul 28, 2021

Last updated

Jul 28, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Nathan Kelley Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 11, 2024 through Jan 11, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1627430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627430400000",
    "number": "1306519145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "431 SPOTSWOOD AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235172110",
            "telephone_number": "540-421-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7460 CENTRAL BUSINESS PARK DR",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235132818",
            "telephone_number": "540-421-5001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "NATHANIEL",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-28",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701010683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA BOARD OF COUNSELING LICENSE NUMBER",
            "identifier": "0701010683",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NATHAN",
            "last_name": "KELLEY",
            "credential": "LPC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jessica Joy Kell, M.D.
• Anthony Kellam Jr.
• Marilyn S Kellam, MD
• Brian Kelley
• Katrina L. Kelley, RDH
• Alison M. Kelly, CRNA
• Caitlin Kelly, LPC
• Cynthia S Kelly, M.D.
• Jacqueline Kelly
• James Joseph Kelly Jr., RPH.

• Professional Counselor in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.