Provider Demographics
NPI:1699336875
Name:KELLEY, LAURA R (FNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:R
Last Name:KELLEY
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 1:47 OBERY ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2230
Mailing Address - Country:US
Mailing Address - Phone:087-474-8865
Mailing Address - Fax:
Practice Address - Street 1:47 OBERY ST STE 1A
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2230
Practice Address - Country:US
Practice Address - Phone:500-874-7488
Practice Address - Fax:508-747-6661
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN276099163WE0003X, 363LF0000X
MARN276088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency