Individual
KELLY E W ERNST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
100 BRICKHILL AVE, SOUTH PORTLAND, ME 04106-1999
(207) 773-1728
(207) 772-4062
Mailing address
301C US ROUTE 1, SCARBOROUGH, ME 04074-9701
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN62266
ME
363LF0000X
Family Nurse Practitioner
Primary
CNP111042
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558695783
—
ME
Enumeration date
09/21/2009
Last updated
04/08/2014
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