Healthcare Provider Details

I. General information

NPI: 1811472160
Provider Name (Legal Business Name): KELLEY M MEYER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 CENTER AVE
PITTSBURGH PA
15229-1724
US

IV. Provider business mailing address

8150 PERRY HWY STE 201
PITTSBURGH PA
15237-5200
US

V. Phone/Fax

Practice location:
  • Phone: 412-931-3066
  • Fax: 412-939-9965
Mailing address:
  • Phone: 412-369-9550
  • Fax: 412-369-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN624545
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP019572
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: