Provider Demographics
NPI:1417020207
Name:KELLICUTT, ELEANORE SMITH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ELEANORE
Middle Name:SMITH
Last Name:KELLICUTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-6000
Mailing Address - Country:US
Mailing Address - Phone:607-648-2974
Mailing Address - Fax:
Practice Address - Street 1:BINGHAMTON UNIVERSITY
Practice Address - Street 2:HEALTH SERVICE, VESTAL PKWY EAST
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13902-6000
Practice Address - Country:US
Practice Address - Phone:607-777-2221
Practice Address - Fax:607-777-2881
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily