Provider Demographics
NPI:1629772322
Name:KERRANE, KELLY BRIANA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:BRIANA
Last Name:KERRANE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KELLY KERRANE
Mailing Address - Street 2:41 WASHINGTON STREET
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782
Mailing Address - Country:US
Mailing Address - Phone:516-512-2732
Mailing Address - Fax:
Practice Address - Street 1:10 PINEWOOD LN
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-3321
Practice Address - Country:US
Practice Address - Phone:516-512-2732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF351213-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine