Provider Demographics
NPI:1881047553
Name:TOMPKINS, KELLI (CPH-T)
Entity type:Individual
Prefix:MISS
First Name:KELLI
Middle Name:
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:CPH-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 DAGGETT AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-7200
Mailing Address - Country:US
Mailing Address - Phone:541-851-2054
Mailing Address - Fax:541-883-6104
Practice Address - Street 1:2909 DAGGETT AVE STE 225
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-7200
Practice Address - Country:US
Practice Address - Phone:541-851-2054
Practice Address - Fax:541-883-6104
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ORCPT-0000767183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator