Provider Demographics
NPI:1043452824
Name:KULAK, KELLY L (MSN CRNA)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:L
Last Name:KULAK
Suffix:
Gender:F
Credentials:MSN CRNA
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:WEIDNER-HEYDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA, RN, MSN
Mailing Address - Street 1:PO BOX 5520
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-0520
Mailing Address - Country:US
Mailing Address - Phone:610-954-5810
Mailing Address - Fax:
Practice Address - Street 1:801 OSTRUM ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1000
Practice Address - Country:US
Practice Address - Phone:610-954-5810
Practice Address - Fax:610-954-5480
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN262338L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered