Provider Demographics
NPI:1851418206
Name:HALLORAN, KELLY (MN,RNC,FNP,DNC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:HALLORAN
Suffix:
Gender:F
Credentials:MN,RNC,FNP,DNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1582 W SAN MARCOS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4081
Mailing Address - Country:US
Mailing Address - Phone:760-591-9975
Mailing Address - Fax:760-591-9976
Practice Address - Street 1:1582 W SAN MARCOS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4081
Practice Address - Country:US
Practice Address - Phone:760-591-9975
Practice Address - Fax:760-591-9976
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA319069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily