Provider Demographics
NPI:1306847769
Name:DUFFY-MCKNIGHT, KELLY (CRNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DUFFY-MCKNIGHT
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 1:530 SOUTH ST
Mailing Address - Street 2:SUITE G-20
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2775
Mailing Address - Country:US
Mailing Address - Phone:724-832-9190
Mailing Address - Fax:724-832-8705
Practice Address - Street 1:530 SOUTH ST
Practice Address - Street 2:SUITE G-20
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2775
Practice Address - Country:US
Practice Address - Phone:724-832-9190
Practice Address - Fax:724-832-8705
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP003144G363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S38456Medicare UPIN