Provider Demographics
NPI:1306081435
Name:GAGE-KELLY, ADELINA (ANP)
Entity type:Individual
Prefix:MS
First Name:ADELINA
Middle Name:
Last Name:GAGE-KELLY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:LINA
Other - Middle Name:
Other - Last Name:GAGE-KELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP
Mailing Address - Street 1:3232 ELM ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3050
Mailing Address - Country:US
Mailing Address - Phone:510-869-6511
Mailing Address - Fax:
Practice Address - Street 1:3232 ELM ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3050
Practice Address - Country:US
Practice Address - Phone:510-869-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447221363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health