Provider Demographics
NPI:1780823526
Name:DONNELLY, KELLY ANN FRANCES (FNP)
Entity Type:Individual
Prefix:MS
First Name:KELLY ANN
Middle Name:FRANCES
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:PHYSICIAN SUPPORT SERVICES
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6555 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0302
Practice Address - Country:US
Practice Address - Phone:916-536-3560
Practice Address - Fax:916-536-3567
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335774363LF0000X
CA19166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADE925ZOtherPTAN (PROVIDER TRANSACTION ACCESS NUMBER) FOR THE SMMC GROUP IS DE925Z
NYA400008493Medicare PIN