Provider Demographics
NPI:1831558295
Name:FELLOWS, KERRY ROBINSON (RN, NP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:ROBINSON
Last Name:FELLOWS
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ROWLAND WAY
Mailing Address - Street 2:STE 100
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5054
Mailing Address - Country:US
Mailing Address - Phone:628-336-5205
Mailing Address - Fax:415-493-4913
Practice Address - Street 1:75 ROWLAND WAY
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5037
Practice Address - Country:US
Practice Address - Phone:628-336-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY680724163W00000X
CA824624163W00000X
NYF431246-1363LA2100X
CA95014148363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse