Healthcare Provider Details

I. General information

NPI: 1164064721
Provider Name (Legal Business Name): KELLEY CASTILLON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLEY FITZGERALD

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ABBEYVILLE RD
LANCASTER PA
17603-4603
US

IV. Provider business mailing address

101 ABBEYVILLE RD
LANCASTER PA
17603-4603
US

V. Phone/Fax

Practice location:
  • Phone: 717-291-5991
  • Fax: 717-291-5806
Mailing address:
  • Phone: 717-291-5991
  • Fax: 717-291-5806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP020824
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: