Individual
KELLY OWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4646 BROCKTON AVE STE 203, RIVERSIDE, CA 92506-0104
(951) 394-7028
Mailing address
4646 BROCKTON AVE STE 203, RIVERSIDE, CA 92506-0104
(951) 394-7028
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
NP95019278
CA
Other
Enumeration date
01/17/2022
Last updated
06/05/2023
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