Provider Demographics
NPI:1326753336
Name:HAUMESSER, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HAUMESSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 E MAIN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:ALLEGANY
Mailing Address - State:NY
Mailing Address - Zip Code:14706-1300
Mailing Address - Country:US
Mailing Address - Phone:814-594-7458
Mailing Address - Fax:
Practice Address - Street 1:3261 W STATE RD
Practice Address - Street 2:
Practice Address - City:SAINT BONAVENTURE
Practice Address - State:NY
Practice Address - Zip Code:14778-9800
Practice Address - Country:US
Practice Address - Phone:716-375-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program