# KELLY IRENE NORDLAND

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1538623053
- **Gender:** F
- **Credential:** MS, PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | 023209 | NY | — |
| 363AS0400X | Surgical Physician Assistant | 023209 | NY | Yes |

## Other

- **Enumeration date:** 01/29/2019
- **Last updated:** 04/18/2022