Healthcare Provider Details

I. General information

NPI: 1750779773
Provider Name (Legal Business Name): KELLEY CYR AIKEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S NEW ST
DOVER DE
19904-3571
US

IV. Provider business mailing address

740 S NEW ST
DOVER DE
19904-3571
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-0222
  • Fax: 302-674-0200
Mailing address:
  • Phone: 302-674-0222
  • Fax: 302-674-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000788
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: