Provider Demographics
NPI:1063790285
Name:KELLY, LINDA D (FNP)
Entity type:Individual
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First Name:LINDA
Middle Name:D
Last Name:KELLY
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:331 MAINE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3358
Mailing Address - Country:US
Mailing Address - Phone:207-721-0911
Mailing Address - Fax:207-721-9729
Practice Address - Street 1:331 MAINE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3358
Practice Address - Country:US
Practice Address - Phone:207-721-0911
Practice Address - Fax:207-721-9729
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2016-02-08
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Provider Licenses
StateLicense IDTaxonomies
MEAP111047363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
E400254881Medicare PIN