Basic Information
| Provider Information | |||||||||
| NPI: | 1437733664 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TICHY | ||||||||
| FirstName: | KELLI | ||||||||
| MiddleName: | DEBORAH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12332 N 4TH ST | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801349656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038286059 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 MULLICA HILL RD | ||||||||
| Address2: | |||||||||
| City: | MULLICA HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080624413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566418000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2021 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | NJ | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.