MEDICARE: KATHERYN KELLY

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	174H00000X	Health Educator
2	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1992631477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERYN KELLY

Provider Business Mailing Address
First Line	:	20500 BELSHAW AVE
Second Line	:	DPT# EXCA 1377
City	:	CARSON
State	:	CA
Zip	:	90746-3506
Country	:	US
Telephone Number	:	855-442-5885
Fax Number	:

Provider Business Practice Location Address
First Line	:	20500 BELSHAW AVE
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90746-3506
Country	:	US
Telephone Number	:	855-442-5885
Fax Number	:

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

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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Directions to “ KATHERYN KELLY ” Practice Location

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