Healthcare Provider Details

I. General information

NPI: 1730243825
Provider Name (Legal Business Name): JOSEPH C KELLEY RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 ROSE BLOSSOM CT NW
SALEM OR
97304-1056
US

IV. Provider business mailing address

3020 ROSE BLOSSOM CT NW
SALEM OR
97304-1056
US

V. Phone/Fax

Practice location:
  • Phone: 503-378-0689
  • Fax: 503-391-7422
Mailing address:
  • Phone: 503-378-0689
  • Fax: 503-391-7422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: