=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497680052
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLEY RAE CARBONE NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2026
-----------------------------------------------------
Last Update Date | 06/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1037 MAIN ST
-----------------------------------------------------
City | PEEKSKILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10566-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-402-7400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 49 PRICES SWITCH RD
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10990-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-653-6284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 312876
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------