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NPI Code Detail

MEDICARE: SHAKEIA MONIQUE KELLEY

MEDICARE: SHAKEIA MONIQUE KELLEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1487941902
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAKEIA MONIQUE KELLEY
Provider Business Mailing Address
First Line : 430 N PILGRIM ST
Second Line :
City : STOCKTON
State : CA
Zip : 95205-4428
Country : US
Telephone Number : 209-466-0853
Fax Number :
Provider Business Practice Location Address
First Line : 430 N PILGRIM ST
Second Line :
City : STOCKTON
State : CA
Zip : 95205-4428
Country : US
Telephone Number : 209-466-0853
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2011
Last Update Date : 04/03/2024

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Directions to “ SHAKEIA MONIQUE KELLEY ” Practice Location

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