Individual
KELLY VIAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1090 3RD ST, SOUTH LAKE TAHOE, CA 96150-3485
(530) 543-5660
(530) 542-1619
Mailing address
1111 EMERALD BAY RD, SOUTH LAKE TAHOE, CA 96150-6207
(530) 543-5659
(530) 541-8723
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
18964
CA
Other
Enumeration date
06/08/2009
Last updated
07/16/2014
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