Basic Information
| Provider Information | |||||||||
| NPI: | 1154752608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLY | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 694 GOOD DR | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175443737 | ||||||||
| FaxNumber: | 7175443739 | ||||||||
| Practice Location | |||||||||
| Address1: | 694 GOOD DR | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175443737 | ||||||||
| FaxNumber: | 7175443739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2013 | ||||||||
| LastUpdateDate: | 09/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363LW0102X | SP015590 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363LX0001X | SP015590 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 363L00000X | SP015590 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.