Provider Demographics
NPI:1558303412
Name:KELLY, ANNE E (NP)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:E
Last Name:KELLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 ARNOLD RD
Mailing Address - Street 2:
Mailing Address - City:N ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-1006
Mailing Address - Country:US
Mailing Address - Phone:508-695-6319
Mailing Address - Fax:
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6013
Practice Address - Country:US
Practice Address - Phone:617-632-6484
Practice Address - Fax:617-582-8212
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154213363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily