Healthcare Provider Details

I. General information

NPI: 1922956747
Provider Name (Legal Business Name): KELLI MARIE HITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11633 VICTORY BLVD
NORTH HOLLYWOOD CA
91606-3513
US

IV. Provider business mailing address

11633 VICTORY BLVD
NORTH HOLLYWOOD CA
91606-3513
US

V. Phone/Fax

Practice location:
  • Phone: 888-530-4415
  • Fax: 833-450-5967
Mailing address:
  • Phone: 661-644-5628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95038628
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95038628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: