Provider Demographics
NPI:1568204642
Name:KELLEY, TRISHA (FNP-BC)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 LOCKE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-4017
Mailing Address - Country:US
Mailing Address - Phone:603-520-0673
Mailing Address - Fax:
Practice Address - Street 1:85 LOCKE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-4017
Practice Address - Country:US
Practice Address - Phone:603-520-0673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2349264163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse