Provider Demographics
NPI:1861963845
Name:FARLEY, KELLEY ROBIN (NP)
Entity type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:ROBIN
Last Name:FARLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KELLEY
Other - Middle Name:ROBIN
Other - Last Name:FARLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1747 LOS LAGOS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6625
Mailing Address - Country:US
Mailing Address - Phone:480-404-4896
Mailing Address - Fax:480-400-1063
Practice Address - Street 1:1690 MCCULLOCH BLVD N STE 102
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6560
Practice Address - Country:US
Practice Address - Phone:480-404-4896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ219372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily