Provider Demographics
NPI:1730243825
Name:KELLEY, JOSEPH C (RNFA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:KELLEY
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 ROSE BLOSSOM CT NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-1056
Mailing Address - Country:US
Mailing Address - Phone:503-378-0689
Mailing Address - Fax:503-391-7422
Practice Address - Street 1:3020 ROSE BLOSSOM CT NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-1056
Practice Address - Country:US
Practice Address - Phone:503-378-0689
Practice Address - Fax:503-391-7422
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant