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Individual

LESLIE R KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
30 LOCUST ST, NORTHAMPTON, MA 01060-2052
(413) 582-2441
Mailing address
30 LOCUST ST, NORTHAMPTON, MA 01060-2052
(413) 582-2441

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
191800-30
WI
363L00000X
Nurse Practitioner
Primary
4902-33
WI
363LF0000X
Family Nurse Practitioner
101-0021171
VT
363LF0000X
Family Nurse Practitioner
238190
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1008712
VT
05
110102297A
MA
01
1205946266
BCBSWI
WI
05
1205946266
WI
01
KELLYLES
MERCYCARE INSURANCE
WI
Enumeration date
08/30/2006
Last updated
06/21/2016
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