Provider Demographics
NPI:1861283921
Name:HARFOUCHE, KELLY (NP-BC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:HARFOUCHE
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6185 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-4017
Mailing Address - Country:US
Mailing Address - Phone:410-688-4904
Mailing Address - Fax:
Practice Address - Street 1:1640 CAMINO DEL RIO N SUITE 206
Practice Address - Street 2:ROOM 119/120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:410-688-4904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034787363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily