Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G77600 | CA |
NPI | 1013091958 |
---|---|
Provider Name | Kelly A Kinsley |
First Address | Crescent City, CA 95531-6821 |
Second Address | Arcata, CA 95521-3584 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 23/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F22735 | (02) | MI |