=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679032189
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN KELLY NURSE PRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2019
-----------------------------------------------------
Last Update Date | 02/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 255 W LANCASTER AVE STE 330
-----------------------------------------------------
City | PAOLI
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19301-1766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-565-1600
-----------------------------------------------------
Fax | 484-565-8814
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3803 W CHESTER PIKE STE 160
-----------------------------------------------------
City | NEWTOWN SQUARE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19073-2336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-565-1600
-----------------------------------------------------
Fax | 484-565-8814
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | SP020054
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | SP020054
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------