Provider Demographics
NPI:1013300359
Name:KELLEY, NANCY LEE
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LEE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DEARBORN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-3318
Mailing Address - Country:US
Mailing Address - Phone:603-926-8827
Mailing Address - Fax:
Practice Address - Street 1:2 DEARBORN AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-3318
Practice Address - Country:US
Practice Address - Phone:603-926-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH01523124Q00000X
MADH5053124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist