GEORGIA KELLY-WILLIAMS NPI 1104545037

NPI Information

  • NPI: 1104545037
  • Provider Name: GEORGIA KELLY-WILLIAMS
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 52 TIBER AVE
    DEER PARK, NY
    ZIP 11729
  • Phone: (631) 404-8843

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NPI Details

Georgia Kelly-williams is a psychiatric/mental health nurse practitioner in Deer Park, NY with 4 years of experience. Georgia Kelly-williams NPI is 1104545037. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

52 TIBER AVE
DEER PARK, NY
ZIP 11729-012
Phone: (631) 404-8843

The NPI 1104545037 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/24/2022 and was last updated on 8/24/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0808XNurse PractitionerPsychiatric/Mental Health404380NEW YORKYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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