=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376855114
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLEY ELIZABETH NASH NPP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2010
-----------------------------------------------------
Last Update Date | 08/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1641 3RD ST FL 2
-----------------------------------------------------
City | RENSSELAER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12144-1539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-463-8869
-----------------------------------------------------
Fax | 518-463-8733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 NORTONVILLE RD
-----------------------------------------------------
City | VALLEY FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-805-7099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 430505
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 405689
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 517355
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------