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Individual
ROSEMARIE KELLEY
Active
Individual
ROSEMARIE KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA13565
CA
363AS0400X
Surgical Physician Assistant
PA13565
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CD069A
GROUP PTAN
CA
Enumeration date
10/04/2006
Last updated
04/01/2016
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