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General NPI Number Information
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NPI Number | 1548963861
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Entity Type | Individual
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Provider Name | KELLY RYAN APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/24/2023
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 640 S. STATE STREET BAYHEALTH WOUND CARE CENTER, 2ND FLOOR
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City | DOVER
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State | DE
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Zip | 19901
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Country | US
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Telephone | 302-744-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 640 S. STATE ST. MAIL CODE 3055
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City | DOVER
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State | DE
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Zip | 19901-3530
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Country | US
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Telephone | 302-480-1688
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Fax | 302-480-9807
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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 | LG-0012296
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | LG-0012296
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License Number State | DE
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