Provider Demographics
NPI:1891945093
Name:WEARY, KELLY MARIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MARIE
Last Name:WEARY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:2500 PALERMO DRIVE SUITE 4
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-7205
Mailing Address - Country:US
Mailing Address - Phone:814-860-3179
Mailing Address - Fax:814-616-7400
Practice Address - Street 1:2500 PALERMO DRIVE SUITE 4
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-7205
Practice Address - Country:US
Practice Address - Phone:814-860-3179
Practice Address - Fax:814-616-7400
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP009943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily