Provider Demographics
NPI:1003273863
Name:MARSHALL, KELLYN (RN)
Entity Type:Individual
Prefix:MS
First Name:KELLYN
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 OAK ST STE 208
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1828
Mailing Address - Country:US
Mailing Address - Phone:541-656-2279
Mailing Address - Fax:541-314-9627
Practice Address - Street 1:208 OAK ST STE 208
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1828
Practice Address - Country:US
Practice Address - Phone:541-656-2279
Practice Address - Fax:541-314-9627
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202008505NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health