Provider Demographics
NPI:1598574188
Name:LEE, KELLEY
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:LEE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3780 ROSIN CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1646
Mailing Address - Country:US
Mailing Address - Phone:916-441-0226
Mailing Address - Fax:916-441-0286
Practice Address - Street 1:630 BERCUT DR STE C
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-0110
Practice Address - Country:US
Practice Address - Phone:916-363-1553
Practice Address - Fax:916-363-1636
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion