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General NPI Number Information
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NPI Number | 1639522816
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Entity Type | Individual
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Provider Name | KRISTIN SKELLY NP
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Gender | Female
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 84 STATE ST
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City | BOSTON
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State | MA
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Zip | 02109-2202
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Country | US
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Telephone | 646-876-8455
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Fax | 833-314-0246
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Provider Business Mailing Address
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Address Line | 228 PARK AVE S STE 16389
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City | NEW YORK
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State | NY
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Zip | 10003-1502
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Country | US
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Telephone | 646-876-8455
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Fax | 833-314-0246
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | TPAN2755
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN01401
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | TPAN2755
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | RN225032
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License Number State | MA
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