Active NPI
Kelly Catherine Defeo, CRNA , APRN, PHD
- Family Nurse Practitioner
- Glen, NH
National Provider Identifier
1699757906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 04717023
- Practice address
- 15 US Rte 302
Glen, NH 03838-6300 - Phone
- (603) 730-5356
- Fax
- (603) 730-5477
- NPI assigned
- Nov 14, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 047170-23-11 | NH | |
| Family Nurse Practitioner | 363LF0000X | 04717023 | NH | Primary |
Addresses
Primary practice location
15 US Rte 302
Glen, NH 03838-6300
Mailing address
PO Box 125
Center Conway, NH 03813-0125
Phone (603) 730-5356
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30342118 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140417001454 | NH | Practitioner - Nurse Practitioner | 4284548439 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
100 Borthwick Ave
Suite 210
Portsmouth, NH 03801-4115
Phone (603) 218-1793
15 US Rte
302 Unit 1
Glen, NH 03838-6300
Phone (603) 730-5356
Hospital & facility affiliations
- Androscoggin Valley Hospital
- Memorial Hospital, the
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse, Nurse Practitioner, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04717023 | NH | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cranmore Health Partners, LLC | Current | Accepting new patients |
Locations
15 US Route 302
Unit 1
Glen, NH 03838
Phone (603) 730-5356
1857 White Mountain Hwy
North Conway, NH 03860
Phone (603) 387-4523
Organizations & group practices 2
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.
-
- Certified Registered Nurse Anesthetist
- Seabrook, NH
- NPI 1053289629
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Durable Medical Equipment & Medical Supplies
- Berlin, NH
- NPI 1235267451
Hospital
-
- Endocrinology, Diabetes & Metabolism Physician
- North Conway, NH
- NPI 1629060926
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744070400000",
"number": "1699757906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 125",
"city": "CENTER CONWAY",
"state": "NH",
"postal_code": "038130125",
"telephone_number": "603-730-5356",
"fax_number": "603-730-5477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 US RTE 302",
"city": "GLEN",
"state": "NH",
"postal_code": "038386300",
"telephone_number": "603-730-5356",
"fax_number": "603-730-5477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEFEO",
"first_name": "KELLY",
"middle_name": "CATHERINE",
"name_prefix": "Ms.",
"credential": "CRNA , APRN, PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-11-14",
"last_updated": "2025-04-08",
"certification_date": "2025-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "NH",
"license": "047170-23-11",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NH",
"license": "04717023",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30342118",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glen, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.