Healthcare Provider Details

I. General information

NPI: 1245880947
Provider Name (Legal Business Name): KELLY ANNE SAVILLE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD STE 1070
NEWARK DE
19718-2200
US

IV. Provider business mailing address

306 SCOLA RD
BROOKHAVEN PA
19015-1414
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-4534
  • Fax:
Mailing address:
  • Phone: 610-945-8442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0043825
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN649747
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP019855
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0001319
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: