Healthcare Provider Details

I. General information

NPI: 1982987889
Provider Name (Legal Business Name): KELLY CARMICHAEL R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 COURT ST
SYRACUSE NY
13208-3234
US

IV. Provider business mailing address

2707 COURT ST
SYRACUSE NY
13208-3234
US

V. Phone/Fax

Practice location:
  • Phone: 315-455-7571
  • Fax: 315-455-7573
Mailing address:
  • Phone: 315-455-7571
  • Fax: 315-455-7573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number342989-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: