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General NPI Number Information
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NPI Number | 1881232387
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Entity Type | Individual
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Provider Name | KELLEY ELIZABETH DRISCOLL NP
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Gender | Female
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Dates
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Enumeration Date | 12/16/2019
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 3559 E SOUTH ST
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City | LONG BEACH
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State | CA
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Zip | 90805-4519
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Country | US
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Telephone | 562-354-4410
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Fax | 888-972-1912
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Provider Business Mailing Address
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Address Line | 2920 TELEGRAPH AVE STE 100
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City | BERKELEY
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State | CA
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Zip | 94705-2031
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Country | US
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Telephone | 442-347-7418
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Fax | 888-972-1912
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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 | 345118
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License Number State | NY
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