Provider Demographics
NPI:1710047220
Name:TILMON-KELLUM, ROSEMARY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:
Last Name:TILMON-KELLUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:KELLUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1250 BELLFLOWER BLVD
Mailing Address - Street 2:STUDENT HEALTH CENTER
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90840
Mailing Address - Country:US
Mailing Address - Phone:562-985-4771
Mailing Address - Fax:562-985-1644
Practice Address - Street 1:1250 BELLFLOWER BLVD.
Practice Address - Street 2:STUDENT HEALTH CENTER
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90840
Practice Address - Country:US
Practice Address - Phone:562-985-4771
Practice Address - Fax:562-985-1644
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13327363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical