Provider Demographics
NPI:1073634473
Name:KELLEY, MARIA A (APN)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:A
Last Name:KELLEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 CARSON RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-5116
Mailing Address - Country:US
Mailing Address - Phone:302-898-1083
Mailing Address - Fax:
Practice Address - Street 1:316 LANTANA DR
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8807
Practice Address - Country:US
Practice Address - Phone:302-234-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008826363LF0000X
DELG 0000390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily