Provider Demographics
NPI:1851319347
Name:KELLY, MARY HIGGINS (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HIGGINS
Last Name:KELLY
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 1:1235 OLD YORK RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19111
Mailing Address - Country:US
Mailing Address - Phone:215-517-1200
Mailing Address - Fax:215-517-1219
Practice Address - Street 1:1235 OLD YORK RD
Practice Address - Street 2:SUITE 121
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3800
Practice Address - Country:US
Practice Address - Phone:215-517-1200
Practice Address - Fax:215-517-1219
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP004416C363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1224376Medicaid
PA014850GPJMedicare ID - Type Unspecified
PA1224376`Medicaid