Kackley, Russell
Kackley, Russell is an individual health care provider with primary practice located at 260 Hospital Dr Ste 103 , Ukiah CA 95482-4568. He recently has only one registered license in Student, Health Care / Student in an Organized Health Care Education/Training Program, which is considered as his primary health care specialty. Kackley, Russell can be contacted via phone (707) 467-3123.Contact Information
Primary practice address
260 Hospital Dr Ste 103
Ukiah CA 95482-4568
Phone: (707) 467-3123
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X |
Profile Details
| NPI number | 1891372553 |
|---|---|
| LBN Legal business name | Kackley, Russell |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 26th, 2021 |
| Last updated | Mar 26th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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