Provider Demographics
NPI:1073122404
Name:KELLEY, DEMI W (RN)
Entity Type:Individual
Prefix:
First Name:DEMI
Middle Name:W
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 6TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4326
Mailing Address - Country:US
Mailing Address - Phone:703-338-8708
Mailing Address - Fax:202-629-3059
Practice Address - Street 1:800 6TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4326
Practice Address - Country:US
Practice Address - Phone:703-338-8708
Practice Address - Fax:202-629-3059
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1050859163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse