Kelly-Ann Deponto, RN, NP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

337132 Issued in NY

Practice address

25 Tri Brook Dr
South Salem, NY 10590-1903

Phone

(914) 774-5565

NPI assigned

Jan 4, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1294099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684281600000",
    "number": "1497059570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 TRI BROOK DR",
            "city": "SOUTH SALEM",
            "state": "NY",
            "postal_code": "105901903",
            "telephone_number": "914-774-5565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 TRI BROOK DR",
            "city": "SOUTH SALEM",
            "state": "NY",
            "postal_code": "105901903",
            "telephone_number": "914-774-5565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEPONTO",
        "first_name": "KELLY-ANN",
        "credential": "RN, NP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-04",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "536560",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "337132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in South Salem, NY
• Providers in South Salem, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2023; 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.