Healthcare Provider Details

I. General information

NPI: 1497678585
Provider Name (Legal Business Name): KELSEY REID
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MIDDLE TPKE W STE 100
MANCHESTER CT
06040-3816
US

IV. Provider business mailing address

77 GOULD DR APT D
EAST HARTFORD CT
06118-1164
US

V. Phone/Fax

Practice location:
  • Phone: 860-533-4176
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10.145884
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: