Provider Demographics
NPI:1659553428
Name:KELLEY, JUDITH BEITEL (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:BEITEL
Last Name:KELLEY
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 1:750 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2547
Mailing Address - Country:US
Mailing Address - Phone:610-363-0100
Mailing Address - Fax:
Practice Address - Street 1:250 W LANCASTER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1743
Practice Address - Country:US
Practice Address - Phone:610-889-7530
Practice Address - Fax:610-889-7531
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA166701W9EMedicare PIN