Provider Demographics
NPI:1649468018
Name:O'NEILL, KELLY ANN (RN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885-3206
Mailing Address - Country:US
Mailing Address - Phone:401-247-4278
Mailing Address - Fax:
Practice Address - Street 1:25 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-3206
Practice Address - Country:US
Practice Address - Phone:401-247-4278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN43802163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRR02204Medicaid