Individual
RUTH ELLEN KELLEHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1 TALLOW WOOD DR, CLIFTON PARK, NY 12065
(518) 688-0434
Mailing address
PO BOX 14890, ALBANY, NY 12212-4890
(518) 525-5634
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
380828
NY
363LP0200X
Pediatric Nurse Practitioner
380828
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01879189
—
NY
Enumeration date
04/25/2007
Last updated
05/11/2021
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