MEDICARE: KELLEY SCOTT NP

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	363L00000X	Nurse Practitioner	26NJ00139800	NJ

General Provider Information

NPI Number	:	1790965549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY SCOTT NP

Provider Business Mailing Address
First Line	:	PO BOX 3012
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19804-0012
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	853 MILL CREEK RD
Second Line	:
City	:	MANAHAWKIN
State	:	NJ
Zip	:	08050-4562
Country	:	US
Telephone Number	:	609-756-4667
Fax Number	:	302-224-2848

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

Provider Enumeration Date	:	11/09/2007
Last Update Date	:	10/02/2024

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