Provider Demographics
NPI:1225022460
Name:KELLOGG, VICTORIA ANN (PHD, CRNP, MBA)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:ANN
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:PHD, CRNP, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 MILLGATE RD
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-8573
Mailing Address - Country:US
Mailing Address - Phone:814-355-1871
Mailing Address - Fax:
Practice Address - Street 1:112 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-1246
Practice Address - Country:US
Practice Address - Phone:570-748-1895
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP005195V363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health