Mary Catherine Kelly, PNP
Individual provider Active NPI Pediatric Nurse Practitioner · Riverside, CT
NPI 1306058714 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1306058714
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- F381068-1 (NY)
- Practice address
- 275 Riverside Ave
Riverside, CT 06878-2313 - Phone
- (203) 698-7403
- NPI assigned
- May 6, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F381068-1 | NY | MD | Pediatric Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | F381068-1 | NY | Yes |
Addresses
Primary practice location
275 Riverside Ave
Riverside, CT 06878-2313
Mailing address
275 Riverside Ave
Riverside, CT 06878-2313
Phone (203) 698-7403
Other providers in Riverside, CT
- Iwona Jaworska-Stella
- Jessica Ashley Johnson
- Elam H. Joseph
- Stephen Richard Katz
- Joseph Robert Kearns
- Scott Kesselman
- Aigel Khadeeva
- Sohaib Khalid
- Joseph Kim
- Eleonora S Kishelova
All providers in Riverside, CT · Pediatric Nurse Practitioner in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.