Healthcare Provider Details

I. General information

NPI: 1528749025
Provider Name (Legal Business Name): KELLEN KRAKY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 DRINKER TPKE STE 13
COVINGTON TOWNSHIP PA
18444-7948
US

IV. Provider business mailing address

921 DRINKER TPKE STE 13
COVINGTON TOWNSHIP PA
18444-7948
US

V. Phone/Fax

Practice location:
  • Phone: 570-795-9795
  • Fax: 570-276-0195
Mailing address:
  • Phone: 570-795-9795
  • Fax: 570-276-0195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP027929
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: