Provider Demographics
NPI:1457016578
Name:CONWAY, KELSEY ASHLEY VERA (RN)
Entity Type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:ASHLEY VERA
Last Name:CONWAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:141 ALEXANDER AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-3843
Mailing Address - Country:US
Mailing Address - Phone:347-662-9278
Mailing Address - Fax:
Practice Address - Street 1:141 ALEXANDER AVE APT 1B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-3843
Practice Address - Country:US
Practice Address - Phone:347-662-9278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY803629163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04132017Medicaid