Healthcare Provider Details

I. General information

NPI: 1710248869
Provider Name (Legal Business Name): KELLI ANN NAUGHTON RNC-NIC, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE NICU 9TH FLOOR
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

6445 BOOTH ST APT. 201
REGO PARK NY
11374-4006
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5790
  • Fax:
Mailing address:
  • Phone: 718-997-0997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberF350331
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberF350331
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: