Healthcare Provider Details

I. General information

NPI: 1396275962
Provider Name (Legal Business Name): KELLY EMSWILER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 EISENHOWER BLVD
JOHNSTOWN PA
15904-3307
US

IV. Provider business mailing address

1322 EISENHOWER BLVD
JOHNSTOWN PA
15904-3307
US

V. Phone/Fax

Practice location:
  • Phone: 814-266-8840
  • Fax: 814-266-2176
Mailing address:
  • Phone: 814-266-8840
  • Fax: 814-266-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017555
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP017555
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: