Provider Demographics
NPI:1255436622
Name:HAMATI, KELLY L (CRNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:HAMATI
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 1:618 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1134
Mailing Address - Country:US
Mailing Address - Phone:610-694-8111
Mailing Address - Fax:610-694-0800
Practice Address - Street 1:618 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1134
Practice Address - Country:US
Practice Address - Phone:610-694-8111
Practice Address - Fax:610-694-0800
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007346363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health