Individual
MRS. KELLY MARIA DORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
1021 CHAPEL ST, ONEIDA, NY 13421-2837
(315) 744-6977
Mailing address
1021 CHAPEL ST, ONEIDA, NY 13421-2837
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
645763
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
401708
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
SP022693
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04003563
—
NY
Enumeration date
10/30/2013
Last updated
02/14/2023
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