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Kelly Rackham, FNP-C
Family Nurse Practitioner in Vista, California
NPI 1801497284

Kelly Rackham is a Family Nurse Practitioner based in Vista, CA and is specialized in Family. Kelly Rackham practices in Vista, CA and has the professional credentials of FNP-C. The NPI Number for Kelly Rackham is 1801497284 and holds a License No. 95015717 (California).

The current practice location address for Kelly Rackham is 1000 Vale Terrace Dr, Vista, CA and can be reached out via phone at 844-308-5003.

Location: 1000 Vale Terrace Dr, Vista, CA, 92084-5218
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1801497284
Provider Name
Kelly Rackham
Credential
FNP-C
Provider Entity Type
Individual
Gender
Male
Address
1000 Vale Terrace Dr, Vista, CA, 92084-5218
Phone Number
844-308-5003
Fax Number
Provider Enumeration Date
11/03/2020
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
95015717 01 CA STATE BON
institution
Provider Business Practice Location Address Details
Address
1000 Vale Terrace Dr
City
Vista
State
California
Zip
92084-5218
Phone Number
844-308-5003
Fax Number
person
Provider Business Mailing Address Details
Address
1000 Vale Terrace Dr
City
Vista
State
California
Zip
92084-5218
Phone Number
844-308-5003
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
95015717 (California)
Definition
Definition to come...
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