Provider Demographics
NPI:1356479927
Name:NORD, KELLY WRAY
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:WRAY
Last Name:NORD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:WRAY
Other - Last Name:RICKETTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:585 RIDGE RD.
Mailing Address - Street 2:APT. D
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521
Mailing Address - Country:US
Mailing Address - Phone:707-826-1329
Mailing Address - Fax:
Practice Address - Street 1:720 WOOD ST.
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-268-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator