Provider Demographics
NPI:1346390960
Name:MARTIN, KELLY P (MSN)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:P
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3607 PARY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-2951
Mailing Address - Country:US
Mailing Address - Phone:412-882-8289
Mailing Address - Fax:412-469-8959
Practice Address - Street 1:1200 BROOKS LN STE 260
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3750
Practice Address - Country:US
Practice Address - Phone:412-469-8959
Practice Address - Fax:412-469-7004
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ29268Medicare UPIN