Provider Demographics
NPI:1275369993
Name:KELLY, KERRI LYNN (NBC-HWC)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:LYNN
Last Name:KELLY
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 S ORLEANS RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-2869
Mailing Address - Country:US
Mailing Address - Phone:508-213-1507
Mailing Address - Fax:508-213-1507
Practice Address - Street 1:63 S ORLEANS RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-2869
Practice Address - Country:US
Practice Address - Phone:508-213-1507
Practice Address - Fax:508-213-1507
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAA-3960551171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty