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General NPI Number Information
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NPI Number | 1023743531
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Entity Type | Individual
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Provider Name | KELLY JO KLINE CNM
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Gender | Female
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 152 ZEMAN DR STE 102
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City | EBENSBURG
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State | PA
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Zip | 15931-4130
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Country | US
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Telephone | 814-471-2271
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Fax | 814-471-2216
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Provider Business Mailing Address
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Address Line | 152 ZEMAN DR STE 102
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City | EBENSBURG
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State | PA
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Zip | 15931-4130
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Country | US
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Telephone | 814-471-2277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | MW010689
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License Number State | PA
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