Provider Demographics
NPI:1356833487
Name:KELLY, ROBIN (LPN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:ROBIN
Other - Middle Name:A
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ROBIN BEDOW LPN
Mailing Address - Street 1:4452 W SCIOTA ST
Mailing Address - Street 2:
Mailing Address - City:SCIO
Mailing Address - State:NY
Mailing Address - Zip Code:14880-9771
Mailing Address - Country:US
Mailing Address - Phone:585-593-5446
Mailing Address - Fax:
Practice Address - Street 1:4452 W SCIOTA ST
Practice Address - Street 2:
Practice Address - City:SCIO
Practice Address - State:NY
Practice Address - Zip Code:14880-9771
Practice Address - Country:US
Practice Address - Phone:585-593-5446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216806-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse