Healthcare Provider Details

I. General information

NPI: 1548895428
Provider Name (Legal Business Name): KELLY LEE DROLLETTE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3384 STATE ROUTE 22 STE 3
PERU NY
12972-5305
US

IV. Provider business mailing address

4400 VESTAL PKWY E
BINGHAMTON NY
13902-4601
US

V. Phone/Fax

Practice location:
  • Phone: 518-643-8008
  • Fax: 518-643-8090
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF347881
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number347881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: