Provider Demographics
NPI:1699116202
Name:RUMRILL, KELLY B (ANP-BC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:B
Last Name:RUMRILL
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 ASPEN WAY
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-6054
Mailing Address - Country:US
Mailing Address - Phone:831-724-1164
Mailing Address - Fax:
Practice Address - Street 1:65 ASPEN WAY
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-6054
Practice Address - Country:US
Practice Address - Phone:831-724-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21739363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health