Provider Demographics
NPI:1013346998
Name:CHIEPPA, KELLY A (LPN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:CHIEPPA
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 1:11 SCOTCH PINE DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4220
Mailing Address - Country:US
Mailing Address - Phone:631-379-7034
Mailing Address - Fax:
Practice Address - Street 1:11 SCOTCH PINE DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-4220
Practice Address - Country:US
Practice Address - Phone:631-379-7034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316063164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse