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Individual
KELLY ANNE FAGAN
Active
Individual
KELLY ANNE FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NPP
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
F381648-1
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
229768
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5007235
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
F400995-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03240911
—
NY
Enumeration date
12/14/2006
Last updated
09/29/2026
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