Provider Demographics
NPI:1134562515
Name:TRUE, KELLY MARIE (LPN)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MARIE
Last Name:TRUE
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 1:26 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5622
Mailing Address - Country:US
Mailing Address - Phone:315-520-5631
Mailing Address - Fax:315-368-0195
Practice Address - Street 1:26 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5622
Practice Address - Country:US
Practice Address - Phone:315-520-5631
Practice Address - Fax:315-368-0195
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270524-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse