Provider Demographics
NPI:1558845487
Name:KIM, KELLY ANNE (PNP-AC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:KIM
Suffix:
Gender:F
Credentials:PNP-AC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANNE
Other - Last Name:HOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3701 WEST RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3704
Mailing Address - Country:US
Mailing Address - Phone:925-324-5137
Mailing Address - Fax:
Practice Address - Street 1:1975 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2351
Practice Address - Country:US
Practice Address - Phone:925-324-5137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009982363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care