Provider Demographics
NPI:1033710009
Name:O'TOOLE, KELLY ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:O'TOOLE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-331-1506
Mailing Address - Fax:631-331-5364
Practice Address - Street 1:4 TECHNOLOGY DR STE 210
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4068
Practice Address - Country:US
Practice Address - Phone:631-331-1506
Practice Address - Fax:631-331-5364
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2021-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY309897363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health