Provider Demographics
NPI:1114573771
Name:CARLIN, KELLY MARIE (RN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:CARLIN
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 1:1408 SWEET HOME RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2783
Mailing Address - Country:US
Mailing Address - Phone:716-247-5281
Mailing Address - Fax:716-204-0670
Practice Address - Street 1:1408 SWEET HOME RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14228-2783
Practice Address - Country:US
Practice Address - Phone:716-247-5281
Practice Address - Fax:716-204-0670
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY771317163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse