Provider Demographics
NPI:1124264239
Name:KELLY, HEATHER ANN ROBRECHT (ARNP)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ANN ROBRECHT
Last Name:KELLY
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Gender:F
Credentials:ARNP
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN: CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7115 GREENBACK LN
Practice Address - Street 2:FL 2
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-6133
Practice Address - Country:US
Practice Address - Phone:916-733-3460
Practice Address - Fax:916-560-0266
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2023-05-24
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Provider Licenses
StateLicense IDTaxonomies
CA21780363LA2200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health