Provider Demographics
NPI:1346200375
Name:GILLOTT, KELLI ANN (MSN CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ANN
Last Name:GILLOTT
Suffix:
Gender:F
Credentials:MSN CRNP
Other - Prefix:MISS
Other - First Name:KELLI
Other - Middle Name:ANN
Other - Last Name:KOBALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN CRNP
Mailing Address - Street 1:22 MILL STREET
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401
Mailing Address - Country:US
Mailing Address - Phone:724-437-1582
Mailing Address - Fax:724-437-8328
Practice Address - Street 1:22 MILL STREET
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401
Practice Address - Country:US
Practice Address - Phone:724-437-1582
Practice Address - Fax:724-437-1571
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN512040L163W00000X
PASP006394B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1991407OtherHIGHMARK
PAGI1324550OtherHIGHMARK
PAQ14252Medicare UPIN
PA078397L5TMedicare PIN