Provider Demographics
NPI:1922731710
Name:KELLY, ASHLEE (LPN)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3043 STATE ROUTE 4
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-9632
Mailing Address - Country:US
Mailing Address - Phone:518-920-2311
Mailing Address - Fax:518-747-2253
Practice Address - Street 1:3043 STATE ROUTE 4
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-9632
Practice Address - Country:US
Practice Address - Phone:518-920-2311
Practice Address - Fax:518-747-2253
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343819164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse