Healthcare Provider Details

I. General information

NPI: 1437528122
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF WESTMORELAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W NEWTON ST
GREENSBURG PA
15601-2861
US

IV. Provider business mailing address

555 W NEWTON ST
GREENSBURG PA
15601-2861
US

V. Phone/Fax

Practice location:
  • Phone: 724-832-7045
  • Fax: 724-832-9165
Mailing address:
  • Phone: 724-832-7045
  • Fax: 724-832-9165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015207
License Number StatePA

VIII. Authorized Official

Name: KAYLA ELLIS
Title or Position: NURSE PRACTITIONER
Credential: CRNP
Phone: 724-244-0181