Provider Demographics
NPI:1205676319
Name:KELLY, ASHLEY ANN
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 BOSLER AVE
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1816
Mailing Address - Country:US
Mailing Address - Phone:443-935-9780
Mailing Address - Fax:
Practice Address - Street 1:616 BOSLER AVE
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1816
Practice Address - Country:US
Practice Address - Phone:443-935-9780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide