MEDICARE: STEFANIE KELLY

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	163W00000X	Registered Nurse	RN1021101	DC

General Provider Information

NPI Number	:	1265861215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE KELLY

Provider Business Mailing Address
First Line	:	1720 NEWTON ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-1914
Country	:	US
Telephone Number	:	646-202-3237
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 NEWTON ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-1914
Country	:	US
Telephone Number	:	646-202-3237
Fax Number	:

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

Provider Enumeration Date	:	11/09/2013
Last Update Date	:	11/09/2013

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Directions to “ STEFANIE KELLY ” Practice Location

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