Provider Demographics
NPI:1821105453
Name:TOWERS, KELLY (PA)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:TOWERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MARTIN AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1761
Mailing Address - Country:US
Mailing Address - Phone:717-721-5800
Mailing Address - Fax:717-721-5858
Practice Address - Street 1:175 MARTIN AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1761
Practice Address - Country:US
Practice Address - Phone:717-721-5800
Practice Address - Fax:717-721-5858
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0A002032363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ54900Medicare UPIN
PA095470UFWMedicare ID - Type Unspecified