Healthcare Provider Details

I. General information

NPI: 1265886071
Provider Name (Legal Business Name): KELLY MORRILL MSN, RN, FNP-BC, CEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY SHANNON MSN, RN, FNP-BC, CEN

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 E STANLEY BLVD
LIVERMORE CA
94550-4200
US

IV. Provider business mailing address

1432 ANSLEY DR
LATHROP CA
95330-8450
US

V. Phone/Fax

Practice location:
  • Phone: 925-373-4500
  • Fax:
Mailing address:
  • Phone: 210-878-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number724598
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: