Individual
MRS. COURTNEY LEE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1000 VALE TERRACE DR, VISTA, CA 92084-5218
(760) 631-5000
Mailing address
1000 VALE TERRACE DR, VISTA, CA 92084-5218
(760) 631-5000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
19352
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19352
LICENSE
CA
Enumeration date
11/12/2009
Last updated
12/29/2020
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