Provider Demographics
NPI:1962458653
Name:KELLY, KIMBERLY A (CRNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
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 1:310 FARM LN
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4732
Mailing Address - Country:US
Mailing Address - Phone:215-348-3990
Mailing Address - Fax:215-348-7705
Practice Address - Street 1:310 FARM LN
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4732
Practice Address - Country:US
Practice Address - Phone:215-348-3990
Practice Address - Fax:215-348-7705
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP006953C363LA2200X
PARN332145L363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001435061OtherPERSONAL CHOICE 65
2119896001OtherAMERIHEALTH HMO
598899143OtherMULTI PLAN
007302OtherAETNA PPO MANAGED CARE
4708888939OtherDEVON
4708888939OtherFIRST HEALTH CCN
0001435061OtherPENNSYLVANIA BLUE SHIELD
1058232OtherKEYSTONE MERCY HEALTH PLA
278862OtherMAMSI
470888939OtherPHCS
CK4397OtherMEDICARE RAILROAD
2119896001OtherAMERIHEALTH ADMINISTRATOR
470888939OtherINTERCOUNTY
P543147OtherOXFORD
PC0140OtherHEALTH NET
007302OtherAETNA HMO
21198960001OtherKEYSTONE HEALTH PLAN EAST
21198960001OtherKEYSTONE HLTHPLAN EAST 65
278862OtherMAMSI
PA056725Q3DMedicare ID - Type Unspecified