Provider Demographics
NPI:1669573614
Name:YOUNG, KELLI B (MSN,CRNP)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:B
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSN,CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:207 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2624
Mailing Address - Country:US
Mailing Address - Phone:215-842-0905
Mailing Address - Fax:215-590-2447
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-590-5657
Practice Address - Fax:215-590-2447
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAVP003706O363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine