Individual
MRS. KELLY PARIS NELLESEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
574 PARK LN, EAGLE, ID 83616-4512
(208) 939-2189
Mailing address
1222 W 1ST ST, MERIDIAN, ID 83642-2204
(208) 887-1391
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-207
ID
Other
Enumeration date
03/21/2007
Last updated
07/08/2007
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