Healthcare Provider Details

I. General information

NPI: 1659553428
Provider Name (Legal Business Name): JUDITH BEITEL KELLEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W LANCASTER AVE SUITE 200
PAOLI PA
19301-1743
US

IV. Provider business mailing address

750 W LINCOLN HWY
EXTON PA
19341-2547
US

V. Phone/Fax

Practice location:
  • Phone: 610-889-7530
  • Fax: 610-889-7531
Mailing address:
  • Phone: 610-363-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP009612
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: