# KELLY ANNE FAGAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1508928920
- **Gender:** F
- **Credential:** NPP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0200X | Pediatric Nurse Practitioner | F381648-1 | NY | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 229768 | NC | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 5007235 | NC | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | F400995-1 | NY | — |

## Other

- **Enumeration date:** 12/14/2006
- **Last updated:** 09/29/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 03240911 | — | NY |