Provider Demographics
NPI:1023565280
Name:HAHN, KELLY (CRNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HAHN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-766-2413
Mailing Address - Fax:717-315-2419
Practice Address - Street 1:435 S KINZER AVE
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-8706
Practice Address - Country:US
Practice Address - Phone:717-766-2413
Practice Address - Fax:717-315-2419
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20486363L00000X
PASP016460363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner