Provider Demographics
NPI:1114395605
Name:MORRIS, KELLIE MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:MARIE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:MARIE
Other - Last Name:CULVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 25033
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92799-5033
Mailing Address - Country:US
Mailing Address - Phone:714-347-1000
Mailing Address - Fax:714-347-1082
Practice Address - Street 1:27882 FORBES RD STE 203
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1267
Practice Address - Country:US
Practice Address - Phone:949-347-2400
Practice Address - Fax:949-347-2424
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14925207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology