Provider Demographics
NPI:1861075566
Name:NINI, KELLI ANN (BS)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:ANN
Last Name:NINI
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:NINI
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 BELLE TERRE BLVD # A
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-1715
Mailing Address - Country:US
Mailing Address - Phone:985-652-0078
Mailing Address - Fax:
Practice Address - Street 1:560 BELLE TERRE BLVD # A
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-1715
Practice Address - Country:US
Practice Address - Phone:985-652-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator