Colleen Denise Kelley, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110840732 Issued in VA

Practice address

11234 Leatherwood Dr
Reston, VA 20191-4607

Phone

(703) 391-0758

Fax

(703) 391-0758

NPI assigned

Jun 9, 2006

Last updated

Nov 23, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290470400000",
    "number": "1861433088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12255 FAIR LAKES PKWY",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220333952",
            "telephone_number": "703-934-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11234 LEATHERWOOD DR",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201914607",
            "telephone_number": "703-391-0758",
            "fax_number": "703-391-0758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "COLLEEN",
        "middle_name": "DENISE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-09",
        "last_updated": "2010-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110840732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Kavanagh, DPT
• Daniel G Kaw, M.D.
• Eskedar Kebede
• Lindsay Anne Keene, FNP-C
• Kevin J Kelleher, MD
• Kelly Holman Physical Therapy
• Amanda Reeder Kelly, PT, DPT
• Erin Kelly, OTR/L
• Julia Loza Kelly, PA-C
• Lawrence F.X. Kelly, M.D.

• Medical Physician Assistant in Reston, VA
• Providers in Reston, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2010; 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.