Provider Demographics
NPI:1477850444
Name:FALK, KELLY JEAN (RN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:FALK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8276 DANISH SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS
Mailing Address - State:WI
Mailing Address - Zip Code:54555-6539
Mailing Address - Country:US
Mailing Address - Phone:715-339-4057
Mailing Address - Fax:
Practice Address - Street 1:W8276 DANISH SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:WI
Practice Address - Zip Code:54555-6539
Practice Address - Country:US
Practice Address - Phone:715-339-4057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-27
Last Update Date:2011-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI155534-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse