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Individual
RICHARD KELLEY
Active
Individual
RICHARD KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA15710
CA
363L00000X
Nurse Practitioner
NP13052
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CD069A
GROUP PTAN GREATER MODESTO MEDICAL SURGICAL ASSOCIATES
CA
Enumeration date
05/24/2006
Last updated
01/03/2022
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