Basic Information
| Provider Information | |||||||||
| NPI: | 1013272939 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KELLEY | ||||||||
| FirstName: | KRISTEN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 PARK STREET | ||||||||
| Address2: | GLENS FALLS HOSPITAL - CREDENTIALING | ||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189265924 | ||||||||
| FaxNumber: | 5189266983 | ||||||||
| Practice Location | |||||||||
| Address1: | 1134 STATE ROUTE 29 | ||||||||
| Address2: | GREENWICH FAMILY HEALTH CENTER | ||||||||
| City: | GREENWICH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128346107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186929861 | ||||||||
| FaxNumber: | 5186927947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2012 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 280120 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.