Provider Demographics
NPI:1184943219
Name:KELLY, LINDA (RN)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:227 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-6443
Mailing Address - Country:US
Mailing Address - Phone:845-562-7326
Mailing Address - Fax:845-565-0826
Practice Address - Street 1:280 BROADWAY
Practice Address - Street 2:NEWBURGH MENTAL HEALTH CLINIC
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-562-7326
Practice Address - Fax:845-565-0826
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY5007261163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse