Individual provider · Type 1 NPI
Kelly Anne Wallis, FNP-C
Family Nurse Practitioner · San Diego, CA
NPI number
1790454130
Active
Practice location
3020 Childrens Way
San Diego, CA 92123-4223
Mailing address
3020 Childrens Way # MC5003
San Diego, CA 92123-4223
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 838204 (NV) |
| Family Nurse Practitioner Primary | 363LF0000X | NP95021594 (CA) |
Family Nurse Practitioner: Definition to come...
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About NPI 1790454130
Kelly Anne Wallis, FNP-C's National Provider Identifier is 1790454130, issued on Sep 9, 2021. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in San Diego, CA. The record was last updated on Oct 27, 2022.