Kelly Lynne Mack
Nurse Practitioner - Psychiatric/Mental Health
2215 Burdett Ave
Troy
, New York 12180-2466
Kelly Lynne Mack
Nurse Practitioner - Psychiatric/Mental Health
2215 Burdett Ave
Troy
, New York 12180-2466
(518) 649-4094
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About
Features
Specialties
- Nurse Practitioner - Psychiatric/Mental Health
Languages spoken
- English
Location
First Address
- Kelly Lynne Mack
- Po Box 14890
- Albany, NY
- Zip : 12212-4890
- Fax : (518) 649-4094
- Phone : (518) 525-5634
Second Address
- Kelly Lynne Mack
- 2215 Burdett Ave
- Troy, NY
- Zip : 12180-2466
- Phone : (518) 271-3554
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 402731 | NY |
National Provider Identifier
| NPI | 1003468273 |
|---|---|
| Provider Name | Kelly Lynne Mack |
| First Address | Albany, NY 12212-4890 |
| Second Address | Troy, NY 12180-2466 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 09/07/2019 |
| Last Update Date | 21/05/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.