Provider Demographics
NPI:1336724962
Name:ECCLES, KELSEY (CRNP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:ECCLES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:PAOLINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2310 CHRISTOPHER COLUMBUS BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-4206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2310 CHRISTOPHER COLUMBUS BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-4206
Practice Address - Country:US
Practice Address - Phone:215-297-6675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily