Provider Demographics
NPI:1972347227
Name:KELLY, CINDY ROCHELLE (CCHT)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:ROCHELLE
Last Name:KELLY
Suffix:
Gender:F
Credentials:CCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 SHEPHERD OF THE HILLS EXPY STE 206
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7101
Mailing Address - Country:US
Mailing Address - Phone:951-775-3400
Mailing Address - Fax:
Practice Address - Street 1:3044 SHEPHERD OF THE HILLS EXPY STE 206
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7101
Practice Address - Country:US
Practice Address - Phone:951-775-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF-CK2041042374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician