Provider Demographics
NPI:1851770754
Name:VO, KELLIE LINH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:LINH
Last Name:VO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9862 CHAPMAN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-2726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9862 CHAPMAN AVE STE B
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-2726
Practice Address - Country:US
Practice Address - Phone:714-418-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-25
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA733417163W00000X
CA95003058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse