Kelley Marie Anderson, LPN
Individual provider Active NPI Licensed Practical Nurse · Brockport, NY
NPI 1710437892 · NPPES record last updated May 19, 2021
Key facts
- NPI
- 1710437892
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 322767-1 (NY)
- Practice address
- 500 White Road
Brockport, NY 14420-9610 - Phone
- (585) 944-4467
- NPI assigned
- Oct 12, 2016
- 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 |
|---|---|---|---|
| 322767-1 | NY | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 322767-1 | NY | Yes |
Addresses
Primary practice location
500 White Road
Brockport, NY 14420-9610
Mailing address
500 White Road
Brockport, NY 14420-9610
Phone (585) 944-4467
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04550001 | Medicaid | NY |
Other names
- Ms. Kelley Marie Glover
Other providers in Brockport, NY
- Karori Mal Aggarwal
- Vinay Rajkumar Aggarwal
- Frances Ajayi
- Karen Allen
- Melissa Allen
- Samantha April
- Stacy Patrice Armstrong
- Joshua Arnold
- Asia L Todd NP in Psychiatry PLLC
- Colleen M Baker
All providers in Brockport, NY · Licensed Practical Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2021. 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.