Active NPI
Kristen Kelly
- Specialist
- Mexico, NY
National Provider Identifier
1093857005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 0263941
- Practice address
- 216 Co RT 64
Mexico, NY 13114 - Phone
- (315) 963-5421
- NPI assigned
- Feb 13, 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 0263941 | NY | Primary |
Addresses
Primary practice location
216 Co RT 64
Mexico, NY 13114
Mailing address
216 Co RT 64
Mexico, NY 13114
Phone (315) 963-5421
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0263941 | NY | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cani PT OT SLP & Psychology PLLC | Specialist | Current | Accepting new patients |
Locations
216 County Route 64
Mexico, NY 13114
Phone (315) 963-0864
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Specialist
- Watertown, NY
- NPI 1114065174
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093857005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "216 CO RT 64",
"city": "MEXICO",
"state": "NY",
"postal_code": "13114",
"telephone_number": "315-963-5421"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "216 CO RT 64",
"city": "MEXICO",
"state": "NY",
"postal_code": "13114",
"telephone_number": "315-963-5421"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "KRISTEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "0263941",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mexico, 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.