Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 7673 | CA |
NPI | 1003867474 |
---|---|
Provider Name | Kelly Ann Doty |
First Address | Ridgecrest, CA 93555-3130 |
Second Address | Ridgecrest, CA 93555-3131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 17/05/2021 |