KARY ANNE KELLY (NPI# 1356795504) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356795504 |
| Entity Type | Individual |
| Full Name | KARY ANNE KELLY |
| Credential | NP-PP |
| Practice Address |
3860 Crater Lake Ave Medford OR 97504-9741 |
| Practice Telephone | 5418581003 |
| Practice Fax Number | 5418574499 |
| Mailing Telephone | 5418581003 |
| Mailing Fax Number | 5418574499 |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2020-07-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
201701664NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
29710.1511 | WY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 500724440 | 05 |
| Street Address |
3860 CRATER LAKE AVE |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-9741 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568465847 | Edward Kerwin | Allergy & Immunology | 3860 Crater Lake Ave, Medford, OR 97504-9741 | 2005-05-31 |
| 1487910766 | Ryan B Israelsen | Allergy & Immunology | 3860 Crater Lake Ave, Medford, OR 97504 | 2012-04-11 |
| 1962503961 | Jaleh Ostovar | Nurse Practitioner | 3860 Crater Lake Ave, Medford, OR 97504-9741 | 2006-09-25 |
| 1811098825 | Jennifer K Milligan | Allergy & Immunology | 3860 Crater Lake Ave, Medford, OR 97504-9741 | 2006-09-25 |
| 1467499475 | Kevin Wilson Parks | Allergy & Immunology | 3860 Crater Lake Ave, Suite A, Medford, OR 97504-9741 | 2006-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679113922 | Elena Chapman | Nurse Practitioner | 293 Salem St 4, Medford, MA 02155 | 2020-01-14 |
| 1770005407 | Suzanne Ellen Sanderson | Nurse Practitioner | 2620 E Barnett Rd Ste H, Medford, OR 97504-8383 | 2017-07-14 |
| 1194189902 | Josephine Magpantay Gaviola | Nurse Practitioner | 101 Main St Ste 116, Medford, MA 02155-4530 | 2016-04-07 |
| 1033514286 | Lauren E Hodgdon | Nurse Practitioner | 1698 E Mcandrews Rd Ste 200, Medford, OR 97504 | 2014-10-30 |
| 1962820209 | Jessica Anne Marie Gunn | Nurse Practitioner | 21 Ohio Trl, Medford, NJ 08055-8931 | 2014-04-03 |
| 1912333451 | Travis Adam Day | Nurse Practitioner | 70 Bower Dr Ste 110, Medford, OR 97501-3689 | 2013-09-16 |
| 1184058703 | Ashley Riley | Nurse Practitioner | 101 Main St Ste 107, Medford, MA 02155-4530 | 2013-08-30 |
| 1578841169 | Shannon Jamerson | Nurse Practitioner | 619 N Front St, Medford, OK 73759-2704 | 2011-07-29 |
| 1891081113 | Debra Jeanne Zenner | Nurse Practitioner | 143 South Gibson St., Medford, WI 54451 | 2011-06-24 |
| 1366763336 | Edward William Walton | Nurse Practitioner | 2 Pinecrest Dr, Medford, NJ 08055-8513 | 2010-06-14 |
| Find all providers in MEDFORD | ||||
Please comment or provide details below to improve the information on KARY ANNE KELLY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.