Provider Demographics
NPI:1053781492
Name:DUDLEY, KELLY LEMIEUX (NP-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LEMIEUX
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KELLY-LYNN
Other - Middle Name:
Other - Last Name:LEMIEUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 ARSENAL ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5742
Mailing Address - Country:US
Mailing Address - Phone:207-624-3967
Mailing Address - Fax:
Practice Address - Street 1:250 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5742
Practice Address - Country:US
Practice Address - Phone:207-624-3967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP151078363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care