Provider Demographics
NPI:1457968943
Name:KELLY, BRYANNA COLLEEN (DNP, AGNP-BC)
Entity Type:Individual
Prefix:
First Name:BRYANNA
Middle Name:COLLEEN
Last Name:KELLY
Suffix:
Gender:F
Credentials:DNP, AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1227
Mailing Address - Country:US
Mailing Address - Phone:516-322-5212
Mailing Address - Fax:
Practice Address - Street 1:2384 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6616
Practice Address - Country:US
Practice Address - Phone:718-727-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3087931363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health