Provider Demographics
NPI:1821419532
Name:BAND, KELLY (AGPC-NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BAND
Suffix:
Gender:F
Credentials:AGPC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 MARSTONS LN
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-1656
Mailing Address - Country:US
Mailing Address - Phone:412-551-2141
Mailing Address - Fax:
Practice Address - Street 1:544 MARSTONS LN
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-1656
Practice Address - Country:US
Practice Address - Phone:412-551-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306756363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health