Provider Demographics
NPI:1659256667
Name:KELLEY, KATHLEEN ANN (CRNP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:KELLEY
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 1:1100 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-1657
Mailing Address - Country:US
Mailing Address - Phone:412-417-3673
Mailing Address - Fax:412-417-3673
Practice Address - Street 1:322 ARMBRUST RD
Practice Address - Street 2:
Practice Address - City:YOUNGWOOD
Practice Address - State:PA
Practice Address - Zip Code:15697-1816
Practice Address - Country:US
Practice Address - Phone:724-635-0147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP033560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine