Provider Demographics
NPI:1245774728
Name:KELLEY, KRYSTINE (CNP)
Entity Type:Individual
Prefix:
First Name:KRYSTINE
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 LIBERTY ST
Mailing Address - Street 2:STE 7
Mailing Address - City:HANSON
Mailing Address - State:MA
Mailing Address - Zip Code:02341-1113
Mailing Address - Country:US
Mailing Address - Phone:781-974-5902
Mailing Address - Fax:
Practice Address - Street 1:430 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:HANSON
Practice Address - State:MA
Practice Address - Zip Code:02341-1113
Practice Address - Country:US
Practice Address - Phone:781-293-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-18
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2275484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily