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General NPI Number Information
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NPI Number | 1154609790
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Entity Type | Individual
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Provider Name | KELLY CHRISTINE MERCER PA-C, MPH
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Gender | Female
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 12/19/2019
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Provider Practice Location Address
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Address Line | 4060 FAIRMOUNT AVE
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City | SAN DIEGO
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State | CA
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Zip | 92105-1608
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Country | US
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Telephone | 619-584-1612
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Fax | 619-578-2588
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Provider Business Mailing Address
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Address Line | 4060 FAIRMOUNT AVE
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City | SAN DIEGO
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State | CA
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Zip | 92105-1608
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Country | US
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Telephone | 619-584-1612
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Fax | 619-578-2588
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA21625
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License Number State | CA
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