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General NPI Number Information
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NPI Number | 1821307646
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Entity Type | Individual
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Provider Name | CARISSA M KELLY CNP
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Gender | Female
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 45 DAN RD
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City | CANTON
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State | MA
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Zip | 02021-2852
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Country | US
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Telephone | 914-525-8692
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Fax | 630-376-7615
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Provider Business Mailing Address
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Address Line | 22 FALES RD
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City | SHARON
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State | MA
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Zip | 02067-1086
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Country | US
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Telephone | 914-525-8692
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Fax | 630-376-7615
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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 | CNP211393
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN276785
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN02561
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License Number State | RI
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 084141-23
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License Number State | NH
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Taxonomy #5
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704397659
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN11021654
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License Number State | FL
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Taxonomy #7
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 7947
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License Number State | CT
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Taxonomy #8
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F311018-01
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License Number State | NY
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