Provider Information for 1083768881
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
TINA C KELLEY
Sex: Female
NPI: 1083768881
Last Updated: 2024-10-15
Certification Date: 2024-10-15
Certification Date: 2024-10-15
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1083768881 | ||||||||||||
| Enumeration Date | 2007-01-22 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 13608 DAY RD GRASS VALLEY, CA 95945-9695 United States Phone: 805-674-8634 | Fax: | ||||||||||||
| Primary Practice Address | 13608 DAY RD GRASS VALLEY, CA 95945-9695 United States Phone: 805-674-8634 | Fax: | ||||||||||||
| Secondary Practice Address(es) | |||||||||||||
| Health Information Exchange |
| ||||||||||||
| Other Identifiers |
| ||||||||||||
| Taxonomy |
|