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General NPI Number Information
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NPI Number | 1134340086
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Entity Type | Individual
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Provider Name | MARY KRIS KELLY FNP
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 GUSTAVE L LEVY PL # 1030
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City | NEW YORK
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State | NY
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Zip | 10029-6500
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Country | US
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Telephone | 212-241-8877
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Fax |
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Provider Business Mailing Address
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Address Line | 244 BATTERY AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-7139
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Country | US
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Telephone | 718-836-2580
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F331104-1
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License Number State | NY
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