Provider Demographics
NPI:1639522816
Name:SKELLY, KRISTIN (NP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:SKELLY
Suffix:
Gender:
Credentials:NP
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Mailing Address - Street 1:228 PARK AVE S STE 16389
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1502
Mailing Address - Country:US
Mailing Address - Phone:646-876-8455
Mailing Address - Fax:833-314-0246
Practice Address - Street 1:84 STATE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-2202
Practice Address - Country:US
Practice Address - Phone:646-876-8455
Practice Address - Fax:833-314-0246
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXTPAN2755363LG0600X
RIAPRN01401363LG0600X
FLTPAN2755363LG0600X
MARN225032363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology