Individual
MRS. KELLY THEO ROULEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
155 BORTHWICK AVE STE 201, PORTSMOUTH, NH 03801
(978) 691-5690
(603) 410-4679
Mailing address
155 BORTHWICK AVE STE 201, PORTSMOUTH, NH 03801-7156
(978) 691-5690
(603) 410-4679
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0734
NH
363A00000X
Physician Assistant
PA1660
ME
Other
Enumeration date
07/14/2009
Last updated
03/04/2021
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