MEDICARE: REGINA KELLY-HARTSHORNE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	26NO/NN09043800	NJ
2	363LP0200X	Pediatric Nurse Practitioner	SP016207	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306949250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA KELLY-HARTSHORNE NP

Provider Business Mailing Address
First Line	:	4201 HENRY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-5409
Country	:	US
Telephone Number	:	215-951-2986
Fax Number	:	215-951-6867

Provider Business Practice Location Address
First Line	:	4201 HENRY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-5409
Country	:	US
Telephone Number	:	215-951-2986
Fax Number	:	215-951-6867

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	11/13/2023

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