Active NPI
Wynette Kellam
- Speech-Language Pathologist
- Danville, VA
National Provider Identifier
1376875732
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2202005654
- Practice address
- 175 Deer Run Rd
Danville, VA 24540-2863 - Phone
- (434) 797-5531
- Fax
- (434) 836-0250
- NPI assigned
- Feb 9, 2010
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2202005654 | VA | Primary |
Addresses
Primary practice location
175 Deer Run Rd
Danville, VA 24540-2863
Mailing address
175 Deer Run Rd
Danville, VA 24540-2863
Phone (434) 797-5531
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004981197 | Medicaid | VA |
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 |
|---|---|---|---|
| 2202005654 | VA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265673600000",
"number": "1376875732",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 DEER RUN RD",
"city": "DANVILLE",
"state": "VA",
"postal_code": "245402863",
"telephone_number": "434-797-5531",
"fax_number": "434-836-0250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 DEER RUN RD",
"city": "DANVILLE",
"state": "VA",
"postal_code": "245402863",
"telephone_number": "434-797-5531",
"fax_number": "434-836-0250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLAM",
"first_name": "WYNETTE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-02-09",
"last_updated": "2010-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "VA",
"license": "2202005654",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004981197",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Danville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.