Provider Demographics
NPI:1568426476
Name:MCNERNEY, KELLIE ANN (RN, NP)
Entity Type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:ANN
Last Name:MCNERNEY
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 COLEMAN DR
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-3241
Mailing Address - Country:US
Mailing Address - Phone:707-678-6174
Mailing Address - Fax:
Practice Address - Street 1:330 ELLIS ST
Practice Address - Street 2:GLIDE HEALTH SERVICES, SUITE 418
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-2735
Practice Address - Country:US
Practice Address - Phone:415-674-6140
Practice Address - Fax:415-673-1037
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 283687363L00000X
CANP 4658363LA2200X, 363LC1500X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health