Provider Demographics
NPI:1659746071
Name:KELLEMS, RENEE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:KELLEMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:KELLEMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:1900 W VALENCIA RD
Mailing Address - Street 2:MINUTECLINIC/
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-6628
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:
Practice Address - Street 1:1900 W VALENCIA RD
Practice Address - Street 2:MINUTECLINIC/
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-6628
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily