Provider Demographics
NPI:1780110676
Name:KELLY, CONSTANCE D (CRNP)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:D
Last Name:KELLY
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:107 GAMMA DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2917
Mailing Address - Country:US
Mailing Address - Phone:412-963-6677
Mailing Address - Fax:412-963-6868
Practice Address - Street 1:107 GAMMA DR
Practice Address - Street 2:SUITE 210
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2917
Practice Address - Country:US
Practice Address - Phone:412-963-6677
Practice Address - Fax:412-963-6868
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
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Provider Licenses
StateLicense IDTaxonomies
PASP017456363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA183794Medicare PIN