Individual
MISS KELLY RAE LONDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 N ACADEMY AVE, DANVILLE, PA 17822-9800
(570) 214-4777
(570) 271-7158
Mailing address
1241 PARKWOOD DR, BELLEFONTE, PA 16823-2520
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA053465
PA
Other
Enumeration date
07/14/2008
Last updated
07/14/2008
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