National Provider Identifier
Kelley Marie Anderson, LPN
Kelley Marie Anderson, LPN is listed in the NPPES registry with a primary specialty of Licensed Practical Nurse in Brockport, NY and a listed phone number of (585) 944-4467.
Profile Overview
- NPI
- 1710437892
- Provider Type
- Individual
- Primary Specialty
- Licensed Practical Nurse
- Enumeration Date
- October 12, 2016
- Last Updated
- May 19, 2021
Practice Location
- 500 White Road
- Brockport, NY 14420-9610
Phone: (585) 944-4467
Specialties
- Licensed Practical Nurse (164W00000X)
Full Record
- NPI
- 1710437892
- Entity Type
- Individual
- Last Name
- Anderson
- First Name
- Kelley
- Middle Name
- Marie
- Name Prefix
- MS.
- Credential
- LPN
- Provider Other Last Name
- Glover
- Provider Other First Name
- Kelley
- Provider Other Middle Name
- Marie
- Provider Other Name Prefix Text
- MS.
- Provider Other Credential Text
- LPN
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 500 White Road
- Mailing City
- Brockport
- Mailing State
- NY
- Mailing ZIP Code
- 14420-9610
- Mailing Country
- US
- Mailing Phone
- (585) 944-4467
- Practice Street Address
- 500 White Road
- Practice City
- Brockport
- Practice State
- NY
- Practice ZIP Code
- 14420-9610
- Practice Country
- US
- Practice Phone
- (585) 944-4467
- Enumeration Date
- October 12, 2016
- Last Updated
- May 19, 2021
- Sex
- Female
- Sole Proprietor
- Yes
- Certification Date
- May 19, 2021
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Licensed Practical Nurse (164W00000X)
- Other Identifiers
- 04550001 (NY)