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NPI Code Detail

MEDICARE: MS. TRACY ANN KELLENBERGER PA-C

MEDICARE: MS. TRACY ANN KELLENBERGER 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
1363A00000XPhysician AssistantMA055406PA

General Provider Information

NPI Number : 1447517776
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TRACY ANN KELLENBERGER PA-C
Provider Business Mailing Address
First Line : 90 WOODS AVE
Second Line :
City : CONESTOGA
State : PA
Zip : 17516-9586
Country : US
Telephone Number : 717-872-5646
Fax Number :
Provider Business Practice Location Address
First Line : 306 N 7TH ST
Second Line :
City : COLUMBIA
State : PA
Zip : 17512-2137
Country : US
Telephone Number : 717-684-9106
Fax Number : 717-684-1666
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2012
Last Update Date : 11/08/2012

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