Provider Demographics
NPI:1528378650
Name:WARREN, KELLY (LPN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 JEFFERSON PLZ
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-4035
Mailing Address - Country:US
Mailing Address - Phone:845-473-5900
Mailing Address - Fax:845-473-6692
Practice Address - Street 1:4 JEFFERSON PLZ
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4035
Practice Address - Country:US
Practice Address - Phone:845-473-5900
Practice Address - Fax:845-473-6692
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299363-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse