Provider Demographics
NPI:1982154951
Name:MCCOUBREY, KELLY (FNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MCCOUBREY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CONANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:MEDDYBEMPS
Mailing Address - State:ME
Mailing Address - Zip Code:04657-4027
Mailing Address - Country:US
Mailing Address - Phone:207-214-9355
Mailing Address - Fax:
Practice Address - Street 1:115 CONANT HILL RD
Practice Address - Street 2:
Practice Address - City:MEDDYBEMPS
Practice Address - State:ME
Practice Address - Zip Code:04657-4027
Practice Address - Country:US
Practice Address - Phone:207-214-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH084388-23363LF0000X
MECNP161166363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health