Provider Demographics
NPI:1134214059
Name:HULIHAN, KELLEY (RPA-C)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:HULIHAN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PALISADES DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-6433
Mailing Address - Country:US
Mailing Address - Phone:518-438-5538
Mailing Address - Fax:315-448-6325
Practice Address - Street 1:5 PALISADES DR
Practice Address - Street 2:SUITE 220
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-6433
Practice Address - Country:US
Practice Address - Phone:518-438-5538
Practice Address - Fax:315-448-6325
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004338363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02300004338Medicaid
NY03223705Medicaid
NY03223705Medicaid
NYJ400015220Medicare PIN
NYJ400012270Medicare PIN