Individual
MS. KELLY CATHERINE DEFEO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA , APRN, PHD
Contact information
Practice address
15 US RTE 302, GLEN, NH 03838-6300
(603) 730-5356
(603) 730-5477
Mailing address
PO BOX 125, CENTER CONWAY, NH 03813-0125
(603) 730-5356
(603) 730-5477
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
04717023
NH
367500000X
Certified Registered Nurse Anesthetist
047170-23-11
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30342118
—
NH
Enumeration date
11/14/2005
Last updated
04/08/2025
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