Provider Demographics
NPI:1881232387
Name:DRISCOLL, KELLEY ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:ELIZABETH
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:2920 TELEGRAPH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2031
Mailing Address - Country:US
Mailing Address - Phone:442-347-7418
Mailing Address - Fax:888-972-1912
Practice Address - Street 1:3559 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-4519
Practice Address - Country:US
Practice Address - Phone:562-354-4410
Practice Address - Fax:888-972-1912
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2023-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY345118363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily