Provider Demographics
NPI:1609021070
Name:KELLEY, LORRAINE CAROL (NNP-BC)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:CAROL
Last Name:KELLEY
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:CAROL
Other - Last Name:DIERING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP-BC
Mailing Address - Street 1:PO BOX 1657
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66601-1657
Mailing Address - Country:US
Mailing Address - Phone:785-295-8108
Mailing Address - Fax:785-231-5991
Practice Address - Street 1:1700 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2489
Practice Address - Country:US
Practice Address - Phone:785-295-8270
Practice Address - Fax:785-295-5512
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5374912121163WN0002X
CO124986163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care