Provider Demographics
NPI:1558325183
Name:KELLY BROWN, TISHA A (APRN)
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:A
Last Name:KELLY BROWN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:TISHA
Other - Middle Name:ANN
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:1605 N CEDAR CREST BLVD STE 411
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2323
Mailing Address - Country:US
Mailing Address - Phone:610-969-1914
Mailing Address - Fax:610-969-3951
Practice Address - Street 1:2545 SCHOENERSVILLE ROAD
Practice Address - Street 2:LVH-M SOUTH 5TH FLOOR
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7300
Practice Address - Country:US
Practice Address - Phone:484-884-6503
Practice Address - Fax:484-884-6504
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008917363LP0808X
NJ26NJ00106300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA176825JJMMedicare Oscar/Certification