Provider Demographics
NPI:1861485534
Name:FARNAN, KELLY B (NP)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:B
Last Name:FARNAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 MAIN STREET SUITE 320 BOX 160
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SCHOHARIE
Mailing Address - State:NY
Mailing Address - Zip Code:12157
Mailing Address - Country:US
Mailing Address - Phone:518-295-8336
Mailing Address - Fax:518-295-8724
Practice Address - Street 1:284 MAIN STREET SUITE 320
Practice Address - Street 2:
Practice Address - City:SCHOHARIE
Practice Address - State:NY
Practice Address - Zip Code:12157
Practice Address - Country:US
Practice Address - Phone:518-295-8336
Practice Address - Fax:518-295-8724
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY389496-1163W00000X
NY400553363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02153079Medicaid
NY02153079Medicaid