Provider Demographics
NPI:1972857142
Name:WARDROP, KELSEY BETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:BETH
Last Name:WARDROP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:BETH
Other - Last Name:RATESIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3824 NORTHERN PIKE
Mailing Address - Street 2:STE 700
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2141
Mailing Address - Country:US
Mailing Address - Phone:412-457-0060
Mailing Address - Fax:
Practice Address - Street 1:1620 GOLDEN MILE HWY STE 100
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2010
Practice Address - Country:US
Practice Address - Phone:724-733-5151
Practice Address - Fax:724-327-7221
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057016363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA412350Medicare PIN