Provider Demographics
NPI:1770386757
Name:MILLIKEN, KELLY LYN (NBHWC COACH)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYN
Last Name:MILLIKEN
Suffix:
Gender:
Credentials:NBHWC COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 ADAMS ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2039
Mailing Address - Country:US
Mailing Address - Phone:619-889-0534
Mailing Address - Fax:
Practice Address - Street 1:928 ADAMS ST APT 2
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2039
Practice Address - Country:US
Practice Address - Phone:619-889-0534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA157983120171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach