Provider Demographics
NPI:1598936429
Name:DUNN, KELLY NESSON (PSYD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:NESSON
Last Name:DUNN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:NESSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 1031
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93581-1031
Mailing Address - Country:US
Mailing Address - Phone:661-822-4402
Mailing Address - Fax:
Practice Address - Street 1:24900 HIGHWAY 202
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-5558
Practice Address - Country:US
Practice Address - Phone:661-822-4402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24223103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical