Provider Demographics
NPI:1558871053
Name:KELLY, FRANK (RN)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:KELLY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11624 N VIA VENITZIA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-7035
Mailing Address - Country:US
Mailing Address - Phone:209-617-9625
Mailing Address - Fax:
Practice Address - Street 1:11624 N VIA VENITZIA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-7035
Practice Address - Country:US
Practice Address - Phone:209-617-9625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA789398163WE0003X, 163WH1000X, 163WI0500X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty