Provider Demographics
NPI:1194365114
Name:NUCKLEY, KELLY (APRN, FNP-C, PMHNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:NUCKLEY
Suffix:
Gender:F
Credentials:APRN, FNP-C, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 S I 10 SERVICE RD W STE 100
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1884
Mailing Address - Country:US
Mailing Address - Phone:504-846-6901
Mailing Address - Fax:504-838-5706
Practice Address - Street 1:3616 S I 10 SERVICE RD W STE 100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1884
Practice Address - Country:US
Practice Address - Phone:504-846-6901
Practice Address - Fax:504-838-5706
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208427363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily