Provider Demographics
NPI:1992362305
Name:KING, KELLY KNEPPER (PA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:KNEPPER
Last Name:KING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:DIANA
Other - Last Name:KNEPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1000 CLIFFMINE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15275-1007
Mailing Address - Country:US
Mailing Address - Phone:412-787-8476
Mailing Address - Fax:
Practice Address - Street 1:1000 CLIFFMINE RD STE 210
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15275-1007
Practice Address - Country:US
Practice Address - Phone:412-519-5946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08695363A00000X
PAOA006713363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant