Provider Demographics
NPI:1689774184
Name:CANFIELD, KELLY MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MARIE
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:DEPT. OF PSYCHIATRY SUITE 112
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2342
Mailing Address - Country:US
Mailing Address - Phone:315-464-3100
Mailing Address - Fax:315-464-3178
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:DEPT. OF PSYCHIATRY SUITE 112
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2342
Practice Address - Country:US
Practice Address - Phone:315-464-3100
Practice Address - Fax:315-464-3178
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY330559363LF0000X
NY401297363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health