Provider Demographics
NPI:1740782366
Name:OSWALD, KELLI RENEE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:RENEE
Last Name:OSWALD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:KELLI
Other - Middle Name:RENEE
Other - Last Name:YINGLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 RAYLOC DR
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21750-1518
Mailing Address - Country:US
Mailing Address - Phone:301-678-5187
Mailing Address - Fax:301-678-5797
Practice Address - Street 1:525 FULTON DR
Practice Address - Street 2:
Practice Address - City:MC CONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233-8061
Practice Address - Country:US
Practice Address - Phone:717-485-3850
Practice Address - Fax:717-485-3725
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily