Provider Demographics
NPI:1912447624
Name:BRAGG, KELCIE PINICK (DNP, CPNP-AC)
Entity type:Individual
Prefix:
First Name:KELCIE
Middle Name:PINICK
Last Name:BRAGG
Suffix:
Gender:F
Credentials:DNP, CPNP-AC
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2093 SWAN DR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4765
Mailing Address - Country:US
Mailing Address - Phone:714-222-7824
Mailing Address - Fax:
Practice Address - Street 1:2093 SWAN DR
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4765
Practice Address - Country:US
Practice Address - Phone:714-222-7824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95006241363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care