Provider Demographics
NPI:1508691346
Name:SEAMANS, KELLY ELAINE
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ELAINE
Last Name:SEAMANS
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 1:450 E CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4614
Mailing Address - Country:US
Mailing Address - Phone:480-313-0922
Mailing Address - Fax:
Practice Address - Street 1:450 E CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-4614
Practice Address - Country:US
Practice Address - Phone:480-313-0922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD03624830172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver