Provider Demographics
NPI:1578948576
Name:DUFFY, KELLY ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:DUFFY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6306 HERITAGE PT S
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-6366
Mailing Address - Country:US
Mailing Address - Phone:716-812-3663
Mailing Address - Fax:
Practice Address - Street 1:6306 HERITAGE PT S
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-6366
Practice Address - Country:US
Practice Address - Phone:716-812-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY525375163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse