Healthcare Provider Details

I. General information

NPI: 1023367141
Provider Name (Legal Business Name): KERRY-ANN ALYSCIA KELLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 10/31/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 FIRST ST STE 100
PLEASANTON CA
94655
US

IV. Provider business mailing address

4725 FIRST ST STE 100
PLEASANTON CA
94655
US

V. Phone/Fax

Practice location:
  • Phone: 925-734-3333
  • Fax:
Mailing address:
  • Phone: 925-734-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA126079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: