Individual
KELLY THALACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
41 CORPORATE DR # 101, EASTON, PA 18045-2670
(610) 559-9330
Mailing address
1605 N CEDAR CREST BLVD STE 411, ALLENTOWN, PA 18104-2323
(610) 969-1915
(484) 664-7659
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
SP020519
PA
363LG0600X
Gerontology Nurse Practitioner
Primary
SP020519
PA
Other
Enumeration date
01/03/2020
Last updated
04/14/2020
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