Provider Demographics
NPI:1598986283
Name:MANIPPO, KELLI MORGAN (CRNP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:MORGAN
Last Name:MANIPPO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 FRANKLIN STREET
Mailing Address - Street 2:MEMORIAL MEDICAL CENTER
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4305
Mailing Address - Country:US
Mailing Address - Phone:814-534-9000
Mailing Address - Fax:814-534-7694
Practice Address - Street 1:1086 FRANKLIN STREET
Practice Address - Street 2:MEMORIAL MEDICAL CENTER
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4305
Practice Address - Country:US
Practice Address - Phone:814-534-9000
Practice Address - Fax:814-534-7694
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009172363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care