Provider Demographics
NPI:1326514886
Name:EARLS, KELLY ANN (RN, PHN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:EARLS
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-5406
Mailing Address - Country:US
Mailing Address - Phone:661-631-5895
Mailing Address - Fax:661-631-5898
Practice Address - Street 1:1300 BAKER ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-4326
Practice Address - Country:US
Practice Address - Phone:661-631-5895
Practice Address - Fax:661-631-5898
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA517268163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse