Healthcare Provider Details

I. General information

NPI: 1285955682
Provider Name (Legal Business Name): KELLYE CHRISTINE CARDER AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2010
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 CREAMERY WAY SUITE 103
EXTON PA
19341-2533
US

IV. Provider business mailing address

1 COMMERCE BLVD SUITE 201
WEST GROVE PA
19390-9198
US

V. Phone/Fax

Practice location:
  • Phone: 610-384-8300
  • Fax: 610-384-8885
Mailing address:
  • Phone: 610-395-0977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT006168
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: