Provider Demographics
NPI:1770112195
Name:PELLETIER, KELLY (ARNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:PELLETIER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MERRILL DR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03442-4510
Mailing Address - Country:US
Mailing Address - Phone:603-748-7496
Mailing Address - Fax:
Practice Address - Street 1:677 COURT ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1702
Practice Address - Country:US
Practice Address - Phone:603-357-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH20100054363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care