Healthcare Provider Details

I. General information

NPI: 1538416219
Provider Name (Legal Business Name): KELLY EURICH BESHORE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY MARIE EURICH PA-C

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 E MAIN ST
ANNVILLE PA
17003-1643
US

IV. Provider business mailing address

225 GRANDVIEW AVE STE 303
CAMP HILL PA
17011-1740
US

V. Phone/Fax

Practice location:
  • Phone: 717-988-0580
  • Fax: 717-221-5591
Mailing address:
  • Phone: 717-761-4141
  • Fax: 717-761-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0000837
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA055561
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: