Provider Demographics
NPI:1609031277
Name:DEAN-KELLY, LOUISE ANN (DNS FNP)
Entity Type:Individual
Prefix:PROF
First Name:LOUISE
Middle Name:ANN
Last Name:DEAN-KELLY
Suffix:
Gender:F
Credentials:DNS FNP
Other - Prefix:MS
Other - First Name:LOUISE
Other - Middle Name:ANN
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 3050
Mailing Address - Street 2:SUNYIT HEALTH AND WELLNESS CENTER
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13504-3050
Mailing Address - Country:US
Mailing Address - Phone:315-792-7172
Mailing Address - Fax:
Practice Address - Street 1:12 N HORATIO STREET
Practice Address - Street 2:SUNYIT HEALTH AND WELLNESS CENTER
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13504-3050
Practice Address - Country:US
Practice Address - Phone:315-792-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330446 1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily