| Doctor Name: | MS. KELLYN MARSHALL |
| NPI Number: | 1003273863 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 201393222RN |
| Business Practice Address: | 221 W Main St Medford, OR - 975012728 |
| Business Phone Number: | 5412002369 |
| Business Fax Number: | |
| Mailing Address: | 221 W Main St, MEDFORD |
| State: | OR |
| Postal Code: | 975012728 |
| Phone Number: | 5412002369 |
| Fax Number: | |
| NPI Enumeration Date: | 01/25/2016 |
| NPI Last Update Date: | 01/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WA0400X |
| License Number: | 201393222RN |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |