Healthcare Provider Details

I. General information

NPI: 1346471851
Provider Name (Legal Business Name): KELLY ANN BLACKMON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY ANN RICE NP

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MAIN ST
OLEAN NY
14760-1500
US

IV. Provider business mailing address

515 MAIN ST
OLEAN NY
14760-1598
US

V. Phone/Fax

Practice location:
  • Phone: 716-372-0141
  • Fax: 716-376-2225
Mailing address:
  • Phone: 716-372-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number305220
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF305220-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: