Provider Demographics
NPI:1790661106
Name:LYNCH, KELLY MCCLOSKEY (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MCCLOSKEY
Last Name:LYNCH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 MISSION ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3747
Mailing Address - Country:US
Mailing Address - Phone:831-419-2683
Mailing Address - Fax:
Practice Address - Street 1:133 MISSION ST STE 100
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3747
Practice Address - Country:US
Practice Address - Phone:831-419-2683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95197796163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool