Provider Demographics
NPI:1598924433
Name:KELLEY, RACHEL (AP, DOM)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32302-0024
Mailing Address - Country:US
Mailing Address - Phone:850-544-9900
Mailing Address - Fax:
Practice Address - Street 1:1116 THOMASVILLE RD STE D
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6296
Practice Address - Country:US
Practice Address - Phone:850-544-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1946171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0958OtherBCBS