Provider Demographics
NPI:1093282634
Name:AYALA, KELLY (DNP, APNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:DNP, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 18TH ST # 206
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-2801
Mailing Address - Country:US
Mailing Address - Phone:415-580-0806
Mailing Address - Fax:
Practice Address - Street 1:1459 18TH ST # 206
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-2801
Practice Address - Country:US
Practice Address - Phone:415-580-0806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8788-33363LP2300X
CA95020954363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1093282634Medicaid