Provider Demographics
NPI:1124214978
Name:KELLY, BETH ANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANNE
Last Name:KELLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:ROSOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1245 HIGHLAND AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3714
Mailing Address - Country:US
Mailing Address - Phone:215-481-6070
Mailing Address - Fax:215-481-6076
Practice Address - Street 1:1245 HIGHLAND AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3714
Practice Address - Country:US
Practice Address - Phone:215-481-6070
Practice Address - Fax:215-481-6076
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052682363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA538923Medicare PIN