Provider Demographics
NPI:1356365522
Name:KELLY, JAMES P (APRN)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:KELLY
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2334
Mailing Address - Country:US
Mailing Address - Phone:860-529-5507
Mailing Address - Fax:860-529-5644
Practice Address - Street 1:2080 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-2334
Practice Address - Country:US
Practice Address - Phone:860-529-5507
Practice Address - Fax:860-529-5644
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3272363L00000X
CT003272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400003272CT01OtherANTHEM BLUE SHIELD
CT004257392Medicaid
CT004257392Medicaid
2V6776OtherHEALTHNET
CT004257392Medicaid