Provider Demographics
NPI:1457655532
Name:SWIGART, KELLY LYNNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNNE
Last Name:SWIGART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:LYNNE
Other - Last Name:SWEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1665 VALLEY CENTER PARKWAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017
Mailing Address - Country:US
Mailing Address - Phone:610-868-8460
Mailing Address - Fax:610-868-8435
Practice Address - Street 1:1665 VALLEY CENTER PARKWAY
Practice Address - Street 2:SUITE 150
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017
Practice Address - Country:US
Practice Address - Phone:610-868-8460
Practice Address - Fax:610-868-8435
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054631363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant