Provider Demographics
NPI:1447479928
Name:KELLEY, KATHLEEN (FNP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:ANNE
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1041 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-3240
Mailing Address - Country:US
Mailing Address - Phone:559-856-6090
Mailing Address - Fax:559-856-9092
Practice Address - Street 1:1041 ROSE AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3240
Practice Address - Country:US
Practice Address - Phone:559-856-6090
Practice Address - Fax:559-856-6092
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA469079163W00000X
CA95009506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse