Provider Demographics
NPI:1609181254
Name:KELLY, MARYELLEN S (DNP, CPNP)
Entity Type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:S
Last Name:KELLY
Suffix:
Gender:F
Credentials:DNP, CPNP
Other - Prefix:
Other - First Name:MARYELLEN
Other - Middle Name:S
Other - Last Name:PRIBISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:2301 ERWIN ROAD
Mailing Address - Street 2:CHC - DUKE MEDICAL
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710
Mailing Address - Country:US
Mailing Address - Phone:207-590-0055
Mailing Address - Fax:
Practice Address - Street 1:CHC DUKE MEDICAL
Practice Address - Street 2:2301 ERWIN ROAD
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-684-6994
Practice Address - Fax:919-681-5507
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC276416363L00000X
CA19842363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner