Provider Demographics
NPI:1750662102
Name:KEHINDE, KELLY ANN (LPN, RN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:KEHINDE
Suffix:
Gender:F
Credentials:LPN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 LARKIN RD
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:NY
Mailing Address - Zip Code:13114-3112
Mailing Address - Country:US
Mailing Address - Phone:315-963-2263
Mailing Address - Fax:
Practice Address - Street 1:149 LARKIN RD
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:NY
Practice Address - Zip Code:13114-3112
Practice Address - Country:US
Practice Address - Phone:315-963-2263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY643547-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health