Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | F320052-1 | NY |
NPI | 1447511100 |
---|---|
Provider Name | Barbara M Kelly |
First Address | Ithaca, NY 14850-3326 |
Second Address | Corning, NY 14830-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 25/06/2014 |