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General NPI Number Information
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NPI Number | 1619076528
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Entity Type | Individual
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Provider Name | HOLLY C KELLY MD
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Gender | Female
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 101 ROWLAND WAY
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City | NOVATO
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State | CA
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Zip | 94945-5008
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Country | US
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Telephone | 415-866-9145
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Fax | 415-366-7535
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Provider Business Mailing Address
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Address Line | PO BOX 276950
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City | SACRAMENTO
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State | CA
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Zip | 95827-6950
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Country | US
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Telephone | 866-681-0738
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Fax | 916-854-6769
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | A72149
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A72149
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License Number State | CA
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