Provider Demographics
NPI:1013019348
Name:DALY, KELLY IRENE (APRN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:IRENE
Last Name:DALY
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:51 SEWALL ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2697
Mailing Address - Country:US
Mailing Address - Phone:207-774-5761
Mailing Address - Fax:
Practice Address - Street 1:51 SEWALL ST STE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-774-5761
Practice Address - Fax:207-874-7478
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP181161363LF0000X, 363LF0000X
MEAT3462255A2300X
FLAL21372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer