MEDICARE: MS. KELLEY ROBIN FARLEY NP

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
1	363LF0000X	Family Nurse Practitioner	219372	AZ

General Provider Information

NPI Number	:	1861963845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLEY ROBIN FARLEY NP

Provider Business Mailing Address
First Line	:	1747 LOS LAGOS DR
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6625
Country	:	US
Telephone Number	:	480-404-4896
Fax Number	:	480-400-1063

Provider Business Practice Location Address
First Line	:	1690 MCCULLOCH BLVD N STE 102
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6560
Country	:	US
Telephone Number	:	480-404-4896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	01/30/2024

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