Active NPI
Kelly Ann Pedersen, LPN
- Licensed Practical Nurse
- Rhinebeck, NY
National Provider Identifier
1023160215
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 239071-1
- Practice address
- 190 Foxhollow Rd
Rhinebeck, NY 12572 - Phone
- (845) 876-4275
- NPI assigned
- Jan 17, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 239071-1 | NY | Primary |
Addresses
Primary practice location
190 Foxhollow Rd
Rhinebeck, NY 12572
Mailing address
5 Dogwood Dr
Highland, NY 12528-2443
Phone (845) 883-0366
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 239071-1 | NY | MD | Emergency Medical Services (Emergency Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023160215",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 DOGWOOD DR",
"city": "HIGHLAND",
"state": "NY",
"postal_code": "125282443",
"telephone_number": "845-883-0366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "190 FOXHOLLOW RD",
"city": "RHINEBECK",
"state": "NY",
"postal_code": "12572",
"telephone_number": "845-876-4275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSEN",
"first_name": "KELLY",
"middle_name": "ANN",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "239071-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rhinebeck, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.