MEDICARE: SIMONE KELLEY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	357793	NY

General Provider Information

NPI Number	:	1154290393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMONE KELLEY NP

Provider Business Mailing Address
First Line	:	1097 BOWEN DR E
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-2807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6941 ELAINE DR
Second Line	:
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14304-2877
Country	:	US
Telephone Number	:	716-473-1836
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2025
Last Update Date	:	12/20/2025

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