Provider Demographics
NPI:1538949730
Name:SWINGLY, KELLI ANN (RN)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:ANN
Last Name:SWINGLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3487 EATON RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589-9524
Mailing Address - Country:US
Mailing Address - Phone:585-315-9921
Mailing Address - Fax:
Practice Address - Street 1:3487 EATON RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589-9524
Practice Address - Country:US
Practice Address - Phone:585-315-9921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406993163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse