Provider Demographics
NPI:1457620759
Name:FERRIS, KELLI ANN
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:ANN
Last Name:FERRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-6962
Mailing Address - Country:US
Mailing Address - Phone:307-637-8698
Mailing Address - Fax:
Practice Address - Street 1:922 TAFT AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-6962
Practice Address - Country:US
Practice Address - Phone:307-637-8698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator