Provider Demographics
NPI:1821214180
Name:MANN, GARY KELLEY (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:KELLEY
Last Name:MANN
Suffix:
Gender:M
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NUNDA
Mailing Address - State:NY
Mailing Address - Zip Code:14517-9763
Mailing Address - Country:US
Mailing Address - Phone:585-468-1037
Mailing Address - Fax:
Practice Address - Street 1:28 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ALFRED
Practice Address - State:NY
Practice Address - Zip Code:14802-1104
Practice Address - Country:US
Practice Address - Phone:607-587-8143
Practice Address - Fax:607-587-9175
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335183363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily