Healthcare Provider Details

I. General information

NPI: 1659368595
Provider Name (Legal Business Name): SUSAN R KELLY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN R. CARNEGIE

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 11/25/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 PLEASANT ST STE 1
CONCORD NH
03301
US

IV. Provider business mailing address

280 PLEASANT ST STE 1
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-8665
  • Fax: 833-413-4978
Mailing address:
  • Phone: 603-622-8665
  • Fax: 833-413-4978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN048-042-21
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number048042-23
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN048042-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: