Provider Demographics
NPI:1073512810
Name:KELLEY, JANET E (CRNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:E
Last Name:KELLEY
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 1:11990 N CENTRAL EXPY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3714
Mailing Address - Country:US
Mailing Address - Phone:469-924-3262
Mailing Address - Fax:469-624-3426
Practice Address - Street 1:5035 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2013
Practice Address - Country:US
Practice Address - Phone:814-480-7789
Practice Address - Fax:814-480-7790
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126300363LA2200X
PAVP003650C363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
021074Medicare PIN
PA0210741KPEMedicare PIN