Provider Demographics
NPI:1689620916
Name:KEAN, KELLY A (ARNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:KEAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 LITTLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-1427
Mailing Address - Country:US
Mailing Address - Phone:603-964-3392
Mailing Address - Fax:603-964-3396
Practice Address - Street 1:65 LAFAYETTE RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:NORTH HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03862-2480
Practice Address - Country:US
Practice Address - Phone:603-964-3392
Practice Address - Fax:603-964-3396
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH033294-21363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30342746Medicaid
ME403160099Medicaid
MA000366111Medicaid
NH40Y005383NH01OtherANTHEM BLUECROSS
Q07698Medicare UPIN
NH30342746Medicaid