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Individual
MICHELLE F. MATTISON-KELLY
Active
Individual
MICHELLE F. MATTISON-KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G75193
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000810807764
PHCS
CA
05
—
00G751930
—
CA
01
—
053101
HEALTH NET
CA
01
—
1055017
FIRST HEALTH
CA
01
—
1091569
GREAT WEST
CA
01
—
1140767
CIGNA
CA
01
—
1969350
UNITED HEALTHCARE
CA
01
—
28799
INTERPLAN
CA
01
—
7442156
AETNA
CA
01
—
90079685
PACIFICARE
CA
01
—
G75193
BLUE CROSS
CA
01
—
MCMG116700
WESTERN HEALTH ADVANTAGE
CA
Enumeration date
08/31/2006
Last updated
02/10/2012
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