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NPI Code Detail

MEDICARE: MRS. KELLYANN ROMERO BS

MEDICARE: MRS. KELLYANN ROMERO BS
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1841374766
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLYANN ROMERO BS
Provider Business Mailing Address
First Line : 1100 W 21ST ST
Second Line :
City : CLOVIS
State : NM
Zip : 88101-4151
Country : US
Telephone Number : 575-769-2345
Fax Number :
Provider Business Practice Location Address
First Line : 1100 W 21ST ST
Second Line :
City : CLOVIS
State : NM
Zip : 88101-4151
Country : US
Telephone Number : 575-769-2345
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 10/13/2016

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