Provider Demographics
NPI:1184183618
Name:PIPER, KELSEY NICOLE
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:NICOLE
Last Name:PIPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 S EUCLID AVE APT 203
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-6556
Mailing Address - Country:US
Mailing Address - Phone:626-221-1293
Mailing Address - Fax:
Practice Address - Street 1:3340 E WHITEBIRCH DR
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-3039
Practice Address - Country:US
Practice Address - Phone:626-599-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator