MEDICARE: MS. KELLI VISCO PETERS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	25MP00002300	NJ
2	363AM0700X	Medical Physician Assistant	25MP00002300	NJ

General Provider Information

NPI Number	:	1336138627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLI VISCO PETERS PA-C

Provider Business Mailing Address
First Line	:	301 LIPPINCOTT DR STE 410
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-4197
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 ROUTE 70 E STE E
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-1855
Country	:	US
Telephone Number	:	856-985-7373
Fax Number	:	856-985-9611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	03/02/2026

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