Healthcare Provider Details

I. General information

NPI: 1619883477
Provider Name (Legal Business Name): KELLY J DURIE CRNP PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 393
BLOOMING GLEN PA
18911-0393
US

IV. Provider business mailing address

17 BROOKDALE DR
NEW BRITAIN PA
18901-5073
US

V. Phone/Fax

Practice location:
  • Phone: 267-625-9201
  • Fax:
Mailing address:
  • Phone: 267-625-9201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP036692
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: