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General NPI Number Information
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NPI Number | 1174924054
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Entity Type | Individual
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Provider Name | MS. MARY KELLY
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Gender | Female
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 14435 15TH AVE
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City | WHITESTONE
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State | NY
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Zip | 11357-2407
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Country | US
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Telephone | 718-746-7682
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Fax |
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Provider Business Mailing Address
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Address Line | 525 EAST 70TH ST DEPT. OF ANESTHESIA
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City | NEW YORK
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State | NY
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Zip | 10021
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Country | US
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Telephone | 212-774-7384
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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 | F-338914-1
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License Number State | NY
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