Provider Demographics
NPI:1992022156
Name:OKELLY, KEVIN ANTHONY (LICENSED PRACTICAL N)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ANTHONY
Last Name:OKELLY
Suffix:
Gender:M
Credentials:LICENSED PRACTICAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 FORT HAMILTON PKWY
Mailing Address - Street 2:UNIT 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1680
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2907 FORT HAMILTON PKWY
Practice Address - Street 2:UNIT 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1680
Practice Address - Country:US
Practice Address - Phone:347-204-0609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271275164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse