Provider Demographics
NPI:1992975288
Name:KELLY, ANNA BINGHAM (CFNP CDE)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:BINGHAM
Last Name:KELLY
Suffix:
Gender:F
Credentials:CFNP CDE
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:B
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 CEDAR SE #405
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106
Mailing Address - Country:US
Mailing Address - Phone:505-764-9535
Mailing Address - Fax:505-924-7336
Practice Address - Street 1:201 CEDAR SE #405
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-764-9535
Practice Address - Fax:505-924-7336
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR42841163WD0400X
NMCNP-01907363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator