Provider Demographics
NPI:1326725276
Name:LYP, KELLY NICOLE (RN, DNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:NICOLE
Last Name:LYP
Suffix:
Gender:F
Credentials:RN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 EISENHOWER AVE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-3288
Mailing Address - Country:US
Mailing Address - Phone:219-252-6357
Mailing Address - Fax:
Practice Address - Street 1:5555 14TH AVE NW APT 410
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3782
Practice Address - Country:US
Practice Address - Phone:219-252-6357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60974458163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP61515269OtherAANP