Provider Demographics
NPI:1790095685
Name:JANKE, KELLY JO (DO)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:JO
Last Name:JANKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:JO
Other - Last Name:SENSENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2104 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-3626
Mailing Address - Fax:
Practice Address - Street 1:2104 HARRISBURG PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015760208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery