Active NPI
Mary K Lemley, APRN
- Pediatric Nurse Practitioner
- New Haven, CT
National Provider Identifier
1104893098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 1603
- Practice address
- 374 Grand Ave
Fair Haven Community Health Center
New Haven, CT 06513 - Phone
- (203) 777-7411
- Fax
- (203) 777-8506
- NPI assigned
- Mar 1, 2006
- 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 |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 1603 | CT | Primary |
Addresses
Primary practice location
374 Grand Ave
Fair Haven Community Health Center
New Haven, CT 06513
Mailing address
374 Grand Ave
Fair Haven Community Health Center
New Haven, CT 06513
Phone (203) 777-7411
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001603 | CT | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587427200000",
"number": "1104893098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "374 GRAND AVE",
"address_2": "FAIR HAVEN COMMUNITY HEALTH CENTER",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "06513",
"telephone_number": "203-777-7411",
"fax_number": "203-777-8506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "374 GRAND AVE",
"address_2": "FAIR HAVEN COMMUNITY HEALTH CENTER",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "06513",
"telephone_number": "203-777-7411",
"fax_number": "203-777-8506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEMLEY",
"first_name": "MARY",
"middle_name": "K",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-01",
"last_updated": "2020-04-21",
"certification_date": "2020-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "CT",
"license": "1603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.