Healthcare Provider Details

I. General information

NPI: 1699506071
Provider Name (Legal Business Name): KAYLENE KELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WILLOW PLAZA, SUITE 201
VISALIA CA
93291-6213
US

IV. Provider business mailing address

100 WILLOW PLAZA, SUITE 201
VISALIA CA
93291
US

V. Phone/Fax

Practice location:
  • Phone: 559-279-2846
  • Fax: 559-627-1535
Mailing address:
  • Phone: 559-627-9284
  • Fax: 559-627-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: