Provider Demographics
NPI:1538580246
Name:MARRA, KELLY (FNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MARRA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 VETERANS RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4436
Mailing Address - Country:US
Mailing Address - Phone:914-302-8060
Mailing Address - Fax:914-455-2980
Practice Address - Street 1:225 VETERANS RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4436
Practice Address - Country:US
Practice Address - Phone:914-302-8060
Practice Address - Fax:914-455-2980
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily