Doctor Name: | KELLYE JO MCNULTY |
NPI Number: | 1134599376 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHARMD |
License Number: | 0202013067 |
Business Practice Address: | 2081 Thomas Bishop Ln Virginia Beach, VA - 234541129 |
Business Phone Number: | 7576722220 |
Business Fax Number: | |
Mailing Address: | 2081 Thomas Bishop Ln, VIRGINIA BEACH |
State: | VA |
Postal Code: | 234541129 |
Phone Number: | 7576722220 |
Fax Number: | |
NPI Enumeration Date: | 09/30/2015 |
NPI Last Update Date: | 09/30/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261Q00000X |
License Number: | 0202013067 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | VA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |