Provider Demographics
NPI:1710248869
Name:NAUGHTON, KELLI ANN (RNC-NIC, NNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KELLI ANN
Middle Name:
Last Name:NAUGHTON
Suffix:
Gender:F
Credentials:RNC-NIC, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 BOOTH ST
Mailing Address - Street 2:APT. 201
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4006
Mailing Address - Country:US
Mailing Address - Phone:718-997-0997
Mailing Address - Fax:
Practice Address - Street 1:550 1ST AVE
Practice Address - Street 2:NICU 9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-5790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF350331363LN0000X, 363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal