Provider Demographics
NPI:1437528122
Name:PEDIATRIC ASSOCIATES OF WESTMORELAND
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF WESTMORELAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:724-244-0181
Mailing Address - Street 1:555 W NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2861
Mailing Address - Country:US
Mailing Address - Phone:724-832-7045
Mailing Address - Fax:724-832-9165
Practice Address - Street 1:555 W NEWTON ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2861
Practice Address - Country:US
Practice Address - Phone:724-832-7045
Practice Address - Fax:724-832-9165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty