Kelsey A Fantino, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110006774 Issued in VA

Practice address

817 Volvo Pkwy
Chesapeake, VA 23320-2855

Phone

(757) 668-4630

NPI assigned

Mar 28, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Childrens Hospital of the Kings Daughters Inc

  • Urgent Care Clinic/Center
  • Chesapeake, VA
  • NPI 1578954590
  Medicare reassignment
• Childrens Hospital of the Kings Daughters Inc

  • Clinical Social Worker
  • Norfolk, VA
  • NPI 1467641829
  NPD

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

{
    "created_epoch": "1553731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666137600000",
    "number": "1780145110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "817 VOLVO PKWY",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233202855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "817 VOLVO PKWY",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233202855",
            "telephone_number": "757-668-4630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANTINO",
        "first_name": "KELSEY",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-28",
        "last_updated": "2022-10-19",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110006774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Medical Supply Inc
• Family Medicine Healthcare PLLC
• Family Redirection Institute, Inc.
• Chenzirah Makeal Fannings, LPC
• Amanda Fansler, PHARMD
• Linda Marie Farkas, M.D.
• Tristan Farnen, PT,DPT
• Farrah Farooqi
• Alireza Farpour, M.D.
• Hannah Farrar, DDS

• Physician Assistant in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.