Healthcare Provider Details

I. General information

NPI: 1578285284
Provider Name (Legal Business Name): KELLY YURKOSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2279 45TH ST
SACRAMENTO CA
95817-1514
US

IV. Provider business mailing address

150 PERRY CT
FOLSOM CA
95630-5031
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number757507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: