Active NPI
Gerald Bryan Kelley, D.D.S.
- Dentist
- Big Stone Gap, VA
National Provider Identifier
1346480019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401003752
- Practice address
- 5303 Skeens Ridge Rd
Big Stone Gap, VA 24219-4059 - Phone
- (276) 523-1652
- NPI assigned
- Feb 20, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401003752 | VA | Primary |
Addresses
Primary practice location
5303 Skeens Ridge Rd
Big Stone Gap, VA 24219-4059
Mailing address
5303 Skeens Ridge Rd
Big Stone Gap, VA 24219-4059
Phone (276) 523-1652
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401003752 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235088000000",
"number": "1346480019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5303 SKEENS RIDGE RD",
"city": "BIG STONE GAP",
"state": "VA",
"postal_code": "242194059",
"telephone_number": "276-523-1652"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5303 SKEENS RIDGE RD",
"city": "BIG STONE GAP",
"state": "VA",
"postal_code": "242194059",
"telephone_number": "276-523-1652"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEY",
"first_name": "GERALD",
"middle_name": "BRYAN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-02-20",
"last_updated": "2009-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401003752",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Big Stone Gap, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.