Provider Demographics
NPI:1225540917
Name:GAVRISH, KARLEE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:KARLEE
Middle Name:ANN
Last Name:GAVRISH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KARLEE
Other - Middle Name:ANN
Other - Last Name:CONFORTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:560 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704
Practice Address - Country:US
Practice Address - Phone:570-283-2161
Practice Address - Fax:570-714-0670
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program