Provider Demographics
NPI:1912120932
Name:KELLY, CHRISTINE CHAI (RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:CHAI
Last Name:KELLY
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1569 SLOAT BLVD STE 333
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1255
Mailing Address - Country:US
Mailing Address - Phone:415-353-9339
Mailing Address - Fax:415-353-3450
Practice Address - Street 1:1569 SLOAT BLVD
Practice Address - Street 2:SUITE 333
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1256
Practice Address - Country:US
Practice Address - Phone:415-353-9339
Practice Address - Fax:415-353-3450
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN574014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily