Provider Demographics
NPI:1043694144
Name:MADDEN, KELSEY A (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:A
Last Name:MADDEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:A
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 MORGAN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9139
Mailing Address - Country:US
Mailing Address - Phone:570-586-6637
Mailing Address - Fax:570-587-0547
Practice Address - Street 1:611 MORGAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9139
Practice Address - Country:US
Practice Address - Phone:570-586-6637
Practice Address - Fax:570-587-0547
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily