Individual
MRS. KELLY L GOODMAN-O'LEARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
146 S WILLIAMS ST, BURLINGTON, VT 05401
(802) 656-3340
Mailing address
3300 HENRY AVE STE 401, PHILADELPHIA, PA 19129-1162
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
026.0154533
VT
163W00000X
Registered Nurse
RN721550
PA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
101.0137717
VT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
SP024574
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
026.0154533
RN LICENSE
VT
01
—
101.0137717
CRNP LICENSE NUMBER
VT
01
—
RN721550
RN LICENSE NUMBER
PA
01
—
SP024574
CRNP LICENSE NUMBER
PA
Enumeration date
10/19/2021
Last updated
02/13/2025
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