Provider Demographics
NPI:1275857153
Name:KELLS, DEIRDRE (BC,ANP)
Entity Type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:
Last Name:KELLS
Suffix:
Gender:F
Credentials:BC,ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2060
Mailing Address - Country:US
Mailing Address - Phone:508-532-7918
Mailing Address - Fax:508-853-8593
Practice Address - Street 1:42 CAPE RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3292
Practice Address - Country:US
Practice Address - Phone:800-853-2288
Practice Address - Fax:508-634-3707
Is Sole Proprietor?:No
Enumeration Date:2010-03-20
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194192363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health