Provider Demographics
NPI:1275976995
Name:KELLEY-GRADY, CYNTHIA A (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:A
Last Name:KELLEY-GRADY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HIGH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1435
Mailing Address - Country:US
Mailing Address - Phone:413-887-5130
Mailing Address - Fax:413-733-1924
Practice Address - Street 1:140 HIGH ST STE 300
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1435
Practice Address - Country:US
Practice Address - Phone:413-887-5130
Practice Address - Fax:413-733-1924
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2263526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily