Provider Demographics
NPI:1215039771
Name:ADAMS, KELLEY M (MD)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:M
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9500 GILMAN DR
Mailing Address - Street 2:#0304
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0304
Mailing Address - Country:US
Mailing Address - Phone:858-534-3755
Mailing Address - Fax:858-534-2628
Practice Address - Street 1:9500 GILMAN DR
Practice Address - Street 2:#0304
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0304
Practice Address - Country:US
Practice Address - Phone:858-534-3755
Practice Address - Fax:858-534-2628
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2015-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2006007512084P0800X
KS04-359312084P0800X
CAC1370312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC45639UMedicare UPIN