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1588017446 NPI number — GENEVIEVE MARY KELLEY MD

NPI Number: 1588017446
Health Care Provider/Practitioner: GENEVIEVE MARY KELLEY MD

Information about “1588017446” NPI (GENEVIEVE MARY KELLEY MD) exists in 1588017446 in HTML format HTML  |  1588017446 in plain Text format TXT  |  1588017446 in PDF (Portable Document Format) PDF  |  1588017446 in an XML format XML  formats.

NPI Number : 1588017446 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1588017446",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KELLEY",
    "FirstName": "GENEVIEVE",
    "MiddleName": "MARY",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SAN MARTIN",
    "OtherFirstName": "GENEVIEVE",
    "OtherMiddleName": "MARY",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "580 SAINT JOHNSBURY RD STE K",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LITTLETON",
    "MailingAddressStateName": "NH",
    "MailingAddressPostalCode": "03561-3439",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "603-444-2010",
    "MailingAddressFaxNumber": "603-444-2181",
    "FirstLinePracticeLocationAddress": "580 SAINT JOHNSBURY RD STE K",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LITTLETON",
    "PracticeLocationAddressStateName": "NH",
    "PracticeLocationAddressPostalCode": "03561",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "603-444-2010",
    "PracticeLocationAddressFaxNumber": "603-444-2181",
    "EnumerationDate": "07/15/2016",
    "LastUpdateDate": "01/10/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "9858",
          "LicenseNumberStateCode": "NH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "042.0014582",
          "LicenseNumberStateCode": "VT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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