Provider Demographics
NPI:1487455952
Name:OLIVER, KELLI (CNM)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3769 1ST AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4038
Mailing Address - Country:US
Mailing Address - Phone:619-723-4447
Mailing Address - Fax:
Practice Address - Street 1:3769 1ST AVE APT 14
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4038
Practice Address - Country:US
Practice Address - Phone:619-723-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10013176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife