Provider Demographics
NPI:1750825808
Name:FRANKLIN, KELLENE LYNN (MMP)
Entity Type:Individual
Prefix:MRS
First Name:KELLENE
Middle Name:LYNN
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 GRANT DRIVE
Mailing Address - Street 2:104
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509
Mailing Address - Country:US
Mailing Address - Phone:775-287-4474
Mailing Address - Fax:
Practice Address - Street 1:3670 GRANT DR
Practice Address - Street 2:104
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-7300
Practice Address - Country:US
Practice Address - Phone:775-287-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5037171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor