Individual
JEFFREY KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1800 MULBERRY ST, SCRANTON, PA 18510-2369
(570) 969-8128
Mailing address
PO BOX 319, DUNMORE, PA 18512-0319
(570) 558-2630
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA052458
PA
Other
Enumeration date
11/15/2006
Last updated
07/08/2007
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