Healthcare Provider Details

I. General information

NPI: 1912612854
Provider Name (Legal Business Name): KELLY ANN HASTINGS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY ANN GORMAN

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S CEDAR CREST BLVD STE 405
ALLENTOWN PA
18103-6224
US

IV. Provider business mailing address

2100 MACK BLVD
ALLENTOWN PA
18103-5622
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-8420
  • Fax:
Mailing address:
  • Phone: 484-884-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number717012
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP027365
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: