MEDICARE: MR. KELLY HILAIRE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	347853	NY

General Provider Information

NPI Number	:	1043883572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KELLY HILAIRE FNP

Provider Business Mailing Address
First Line	:	11944 218TH ST
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1911
Country	:	US
Telephone Number	:	718-954-3553
Fax Number	:	877-762-6647

Provider Business Practice Location Address
First Line	:	230 HILTON AVE STE 105
Second Line	:
City	:	HEMPSTEAD
State	:	NY
Zip	:	11550-8116
Country	:	US
Telephone Number	:	718-954-3553
Fax Number	:	877-762-6647

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	05/21/2026

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