Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

MS. Michele Ann Kelly, CPNPNPP

Individual provider Nurse Practitioner · NPI 1457416737

MS. Michele Ann Kelly, CPNPNPP is a Nurse Practitioner in Ronkonkoma, New York. Qualified in 1995, 31 years ago. Accepts Medicare assignment. Licensed in New York.

Years since qualifying
31
Licensed in
NY
In the registry since
2006

Practice location Address checks out

153 Lake Shore Rd Phoenix House Medical Dept
Ronkonkoma, NY 11779
Phone: (631) 471-5666
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence F380749 (NY)

Record details

NPI number1457416737
Entity typeIndividual (Type 1)
GenderFemale
Credentials CPNPNPP
Sole proprietorNo
NPI enumeratedDecember 27, 2006
Last updated in NPPESJuly 8, 2007

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 1995 (31 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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