Provider Demographics
NPI:1508386970
Name:SHORT, KELSEY LEE-ANN (DO)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LEE-ANN
Last Name:SHORT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LEE-ANN
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:96 KISH RD
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17084-8943
Mailing Address - Country:US
Mailing Address - Phone:717-667-7720
Mailing Address - Fax:717-667-7249
Practice Address - Street 1:96 KISH RD
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17084-8943
Practice Address - Country:US
Practice Address - Phone:717-667-7720
Practice Address - Fax:717-667-7249
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019532207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine