Provider Demographics
NPI:1437937869
Name:WALLER, KELSEY ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ELIZABETH
Last Name:WALLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:351 W SCHUYLKILL RD STE G-15A
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-7438
Mailing Address - Country:US
Mailing Address - Phone:610-326-9460
Mailing Address - Fax:
Practice Address - Street 1:351 W SCHUYLKILL RD # G-15A
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-7438
Practice Address - Country:US
Practice Address - Phone:610-326-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028236363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health