Provider Demographics
NPI:1669586913
Name:STENGEL, KELLY MCCANN (MSN, CRNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MCCANN
Last Name:STENGEL
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 PENNSYLVANIA AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3404
Mailing Address - Country:US
Mailing Address - Phone:215-793-4546
Mailing Address - Fax:215-793-9007
Practice Address - Street 1:455 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3403
Practice Address - Country:US
Practice Address - Phone:215-793-4546
Practice Address - Fax:215-793-9007
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007120363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP71054Medicare UPIN
PA063623JM2Medicare ID - Type UnspecifiedKEL MED#