Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Miss. Kelly Mickey Sisowath

Individual provider Rehabilitation Practitioner · NPI 1568076651

Miss. Kelly Mickey Sisowath is a Rehabilitation Practitioner in Clovis, California. Licensed in California. Registered with an NPI since 2020.

Licensed in
CA
In the registry since
2020
Specialties on file
2

Practice location Address checks out

90 W Ashlan Ave Ste 101
Clovis, CA 93612-5627
Phone: (559) 326-5696
Fax: (559) 326-5699
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Rehabilitation Practitioner (primary) Taxonomy 225400000X (CA)
Case Manager/Care Coordinator Taxonomy 171M00000X (CA)

Record details

NPI number1568076651
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedSeptember 4, 2020
Last updated in NPPESSeptember 29, 2025
Certification dateSeptember 29, 2025

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