MEDICARE: KELLY L STORRS 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	320055	NY

General Provider Information

NPI Number	:	1932187374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY L STORRS NP

Provider Business Mailing Address
First Line	:	2660 WEST MAIN ST
Second Line	:
City	:	WHITNEY POINT
State	:	NY
Zip	:	13862
Country	:	US
Telephone Number	:	607-692-3600
Fax Number	:	607-692-3499

Provider Business Practice Location Address
First Line	:	2660 WEST MAIN ST
Second Line	:
City	:	WHITNEY POINT
State	:	NY
Zip	:	13862
Country	:	US
Telephone Number	:	607-692-3600
Fax Number	:	607-692-3499

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	03/19/2012

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