Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | RN 283687 | CA |
N | 363LA2200X | Nurse Practitioner - Adult Health | NP 4658 | CA |
N | 363LC1500X | Nurse Practitioner - Community Health | NP 4658 | CA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | NP 4658 | CA |
NPI | 1568426476 |
---|---|
Provider Name | Ms. Kellie Ann Mcnerney |
First Address | Dixon, CA 95620-3241 |
Second Address | San Francisco, CA 94102-2735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 12/04/2012 |