Provider Demographics
NPI:1760808703
Name:MCCRACKEN, KELLY R (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:R
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:6481 CARLISLE PIKE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-2377
Mailing Address - Country:US
Mailing Address - Phone:717-516-6396
Mailing Address - Fax:717-620-8093
Practice Address - Street 1:6481 CARLISLE PIKE
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-2377
Practice Address - Country:US
Practice Address - Phone:717-516-6396
Practice Address - Fax:717-620-8093
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2020-06-25
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Provider Licenses
StateLicense IDTaxonomies
PAMA056786363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103166579Medicaid