Basic Information
| Provider Information | |||||||||
| NPI: | 1417171240 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLY | ||||||||
| FirstName: | URSULA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | PROF. | ||||||||
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| Credential: | PHD, APRN, BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 COLBERG AVE | ||||||||
| Address2: | |||||||||
| City: | ROSLINDALE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021312710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172831761 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 151 EVERETT AVE | ||||||||
| Address2: | URGENT CARE | ||||||||
| City: | CHELSEA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021501812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178848302 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 196453 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.