Provider Demographics
NPI:1932520996
Name:LAWRENCE, KELLI (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8148 PRINCETON GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-5883
Mailing Address - Country:US
Mailing Address - Phone:513-889-1821
Mailing Address - Fax:
Practice Address - Street 1:8148 PRINCETON GLENDALE RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-5883
Practice Address - Country:US
Practice Address - Phone:513-889-1821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003957363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant