Provider Demographics
NPI:1578285284
Name:YURKOSKY, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:YURKOSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PERRY CT
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-5031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2279 45TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1514
Practice Address - Country:US
Practice Address - Phone:916-734-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA757507163WP0218X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology