Provider Demographics
NPI:1538526991
Name:KELLY-WILSON, PATIENCE
Entity type:Individual
Prefix:
First Name:PATIENCE
Middle Name:
Last Name:KELLY-WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 LLEWELLYN AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1940
Mailing Address - Country:US
Mailing Address - Phone:408-379-3790
Mailing Address - Fax:
Practice Address - Street 1:1898 THE ALAMEDA
Practice Address - Street 2:SAN JOSE
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1733
Practice Address - Country:US
Practice Address - Phone:408-928-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker