Provider Demographics
NPI:1417664806
Name:KELLY, MERCEDES ELAINE (DOULA, CBS)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:ELAINE
Last Name:KELLY
Suffix:
Gender:F
Credentials:DOULA, CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 ELM ST APT 9
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-6714
Mailing Address - Country:US
Mailing Address - Phone:530-487-5636
Mailing Address - Fax:
Practice Address - Street 1:2135 ELM ST APT 9
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-6714
Practice Address - Country:US
Practice Address - Phone:530-487-5636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula