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General NPI Number Information
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NPI Number | 1386714590
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Entity Type | Individual
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Provider Name | COLLEEN J KELLY RNP
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Gender | Female
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | WALTON HIGH SCHOOL 2780 RESERVOIR AVENUE
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City | BRONX
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State | NY
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Zip | 10468
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Country | US
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Telephone | 718-696-4060
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Fax |
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Provider Business Mailing Address
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Address Line | 260 E 201ST ST
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City | BRONX
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State | NY
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Zip | 10458-1840
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Country | US
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Telephone | 718-696-4060
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Fax | 718-562-4357
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F330661
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License Number State | NY
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