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General NPI Number Information
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NPI Number | 1639772528
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Entity Type | Individual
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Provider Name | KELLY GRIGORYAN APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/21/2020
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Last Update Date | 11/21/2020
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Provider Practice Location Address
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Address Line | 5025 J ST STE 206
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City | SACRAMENTO
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State | CA
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Zip | 95819-3839
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Country | US
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Telephone | 916-668-7164
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Fax |
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Provider Business Mailing Address
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Address Line | 4128 STOWE WAY
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City | SACRAMENTO
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State | CA
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Zip | 95864-6058
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Country | US
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Telephone | 978-866-0674
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95015011
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License Number State | CA
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