Basic Information
| Provider Information | |||||||||
| NPI: | 1215039771 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | KELLEY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9500 GILMAN DR | ||||||||
| Address2: | #0304 | ||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920930304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585343755 | ||||||||
| FaxNumber: | 8585342628 | ||||||||
| Practice Location | |||||||||
| Address1: | 9500 GILMAN DR | ||||||||
| Address2: | #0304 | ||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920930304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585343755 | ||||||||
| FaxNumber: | 8585342628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2006 | ||||||||
| LastUpdateDate: | 09/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 200600751 | NC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 04-35931 | KS | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | C137031 | CA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.