Provider Demographics
NPI:1124479183
Name:HALL, KELLY A (DVM)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:37317 PIPPIN PL
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-6918
Mailing Address - Country:US
Mailing Address - Phone:805-304-4922
Mailing Address - Fax:
Practice Address - Street 1:1055 W COLUMBIA WAY
Practice Address - Street 2:#103
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-8155
Practice Address - Country:US
Practice Address - Phone:661-729-1500
Practice Address - Fax:661-729-4500
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA16136207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine