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General NPI Number Information
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NPI Number | 1528410511
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Entity Type | Individual
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Provider Name | KELLEY MCKENNA
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Gender | Female
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 227 W JANSS RD SUITE 340
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1847
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Country | US
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Telephone | 805-852-9100
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Fax | 805-852-9101
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Provider Business Mailing Address
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Address Line | 227 W JANSS RD SUITE 340
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1848
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Country | US
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Telephone | 805-852-9100
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Fax | 844-442-4951
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95004481
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License Number State | CA
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