Healthcare Provider Details

I. General information

NPI: 1497811707
Provider Name (Legal Business Name): LUANN M KELLY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1681 CRANSTON ST STE D
CRANSTON RI
02920-5000
US

IV. Provider business mailing address

1050 WARWICK AVE
WARWICK RI
02888-3660
US

V. Phone/Fax

Practice location:
  • Phone: 401-946-8446
  • Fax: 401-946-8340
Mailing address:
  • Phone: 401-467-6257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberMK1366764
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: