Provider Demographics
NPI:1780108753
Name:PFEIFFENBERGER, KELSEY ANN (CRNP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANN
Last Name:PFEIFFENBERGER
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 1:420 BOW LN
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-9180
Mailing Address - Country:US
Mailing Address - Phone:484-942-6641
Mailing Address - Fax:
Practice Address - Street 1:805 N RICHMOND ST
Practice Address - Street 2:
Practice Address - City:FLEETWOOD
Practice Address - State:PA
Practice Address - Zip Code:19522-1058
Practice Address - Country:US
Practice Address - Phone:610-944-0464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN673265163W00000X
PASP017727363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse