Provider Demographics
NPI:1053675934
Name:KELWOOD, LORRAINE D (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:D
Last Name:KELWOOD
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:P O BOX 370
Mailing Address - Street 2:359A WEST HIGHWAY 264
Mailing Address - City:ST. MICHAELS
Mailing Address - State:AZ
Mailing Address - Zip Code:86511
Mailing Address - Country:US
Mailing Address - Phone:928-810-3800
Mailing Address - Fax:928-810-3811
Practice Address - Street 1:HIGHWAY 163 BUILDING KA 2010
Practice Address - Street 2:KAYENTA HEALTH CENTER
Practice Address - City:KAYENTA
Practice Address - State:AZ
Practice Address - Zip Code:86033
Practice Address - Country:US
Practice Address - Phone:928-697-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily