Individual
MRS. LISA M KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
200 BIDDLE AVE STE 100, NEWARK, DE 19702-3967
(302) 836-7820
Mailing address
PO BOX 191, PROVIDER ENROLLMENT, ROCKLAND, DE 19732-0191
(302) 651-4200
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
L10039633
DE
363LP0200X
Pediatric Nurse Practitioner
SP012767
PA
Other
Enumeration date
04/08/2013
Last updated
04/12/2022
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