Individual
KARY ANNE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-PP
Contact information
Practice address
3860 CRATER LAKE AVE, MEDFORD, OR 97504-9741
(541) 858-1003
(541) 857-4499
Mailing address
3860 CRATER LAKE AVE, MEDFORD, OR 97504-9741
(541) 858-1003
(541) 857-4499
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201701664NP-PP
OR
363LF0000X
Family Nurse Practitioner
29710.1511
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500724440
—
OR
Enumeration date
04/13/2016
Last updated
07/13/2020
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