Mary F Kelley, CRNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

VP002188H Issued in PA

Practice address

330 S 9TH St
Philadelphia, PA 19107-6103

Phone

(215) 829-3053

NPI assigned

Mar 11, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396569600000",
    "number": "1477876928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 S 9TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191076103",
            "telephone_number": "215-829-3053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 S 9TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191076103",
            "telephone_number": "215-829-3053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "MARY",
        "middle_name": "F",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-11",
        "last_updated": "2014-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "PA",
            "license": "VP002188H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cecylia Kelley, D.O.
• Colleen E Kelley, BCO
• Karen Louise Kelley
• Katherine Kelley
• Kevin V. Kelley, BCO
• Tajmah I Kelley, CRNP-BC
• Tamika Kelley
• William N Kelley, MD
• Kelli Care Way of Living LLC (Kelli Care Philadelphia)
• Richard Adam Kellis, MD

• Gerontology Nurse Practitioner in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Gerontology Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.