MEDICARE: KELSI KOK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	816743	CA
2	363LF0000X	Family Nurse Practitioner	95000776	CA

General Provider Information

NPI Number	:	1538571088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSI KOK

Provider Business Mailing Address
First Line	:	902 CIRBY WAY
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-4420
Country	:	US
Telephone Number	:	916-789-1798
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 CIRBY WAY
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-4420
Country	:	US
Telephone Number	:	916-789-1798
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2014
Last Update Date	:	04/14/2016

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Directions to “ KELSI KOK ” Practice Location

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