Provider Demographics
NPI:1689903023
Name:MEAUX, KELLY (NP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:MEAUX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:MCAULIFFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3325 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1911
Mailing Address - Country:US
Mailing Address - Phone:415-767-2640
Mailing Address - Fax:
Practice Address - Street 1:3325 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1911
Practice Address - Country:US
Practice Address - Phone:415-767-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19772363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner