Provider Demographics
NPI:1639537467
Name:FLECKENSTEIN, KELLEY (CNP, RN)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:FLECKENSTEIN
Suffix:
Gender:F
Credentials:CNP, RN
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP, RN
Mailing Address - Street 1:91 JENNIFER DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03036-4178
Mailing Address - Country:US
Mailing Address - Phone:978-270-3980
Mailing Address - Fax:
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3599
Practice Address - Country:US
Practice Address - Phone:603-663-2271
Practice Address - Fax:603-663-2273
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2298942363L00000X, 163W00000X
NH086356-23363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse