Provider Demographics
NPI:1356595391
Name:KELLS, MEREDITH ROSE (NP)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:ROSE
Last Name:KELLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MEREDITH
Other - Middle Name:ROSE
Other - Last Name:DEMAINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:601 ELMWOOD AVE BOX 635
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-2964
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE.
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-2964
Practice Address - Fax:585-242-9733
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA268085163WP0200X
MARN268085363LP0200X
NY383520363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics