Individual
TAMSYN KELLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2180 MAIN ST, WAILUKU, HI 96793-1625
(808) 249-8080
Mailing address
270 PALAMA DR, KAHULUI, HI 96732-1450
(740) 708-2069
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
06/19/2019
Last updated
05/04/2020
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