Healthcare Provider Details

I. General information

NPI: 1568900702
Provider Name (Legal Business Name): KERI O'CALLAGHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5168 N BLYTHE AVE STE 102
FRESNO CA
93722-6478
US

IV. Provider business mailing address

5850 GRANITE PKWY STE 600
PLANO TX
75024-6753
US

V. Phone/Fax

Practice location:
  • Phone: 559-255-5900
  • Fax: 559-981-1212
Mailing address:
  • Phone: 469-694-1754
  • Fax: 818-758-8015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-24163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: