Provider Demographics
NPI:1669223764
Name:KELLYN MARSHALL PMHNP-BC, LLC
Entity type:Organization
Organization Name:KELLYN MARSHALL PMHNP-BC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RATUSNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-656-2279
Mailing Address - Street 1:208 OAK ST STE 208
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1828
Mailing Address - Country:US
Mailing Address - Phone:541-656-2279
Mailing Address - Fax:541-314-9627
Practice Address - Street 1:208 OAK ST STE 208
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1828
Practice Address - Country:US
Practice Address - Phone:541-656-2279
Practice Address - Fax:541-314-9627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty