Provider Demographics
NPI:1932364916
Name:KELLEY, PATRICIA O (NPP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:O
Last Name:KELLEY
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BURHANS PL
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1201
Mailing Address - Country:US
Mailing Address - Phone:518-449-2514
Mailing Address - Fax:518-449-2470
Practice Address - Street 1:756 MADISON AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3823
Practice Address - Country:US
Practice Address - Phone:518-449-2514
Practice Address - Fax:518-449-2470
Is Sole Proprietor?:No
Enumeration Date:2008-07-19
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401154363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03012700Medicaid