Healthcare Provider Details

I. General information

NPI: 1689488702
Provider Name (Legal Business Name): KELLY ALLYSE STAUFFER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 HARRISBURG PIKE STE 312
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

2112 HARRISBURG PIKE STE 312
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberSP032102
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: