Individual
KELLY HAUMESSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
761 JOHNSONBURG RD STE 160, SAINT MARYS, PA 15857-3484
(814) 788-8777
(814) 788-8770
Mailing address
761 JOHNSONBURG RD STE 160, SAINT MARYS, PA 15857-3484
(814) 594-7458
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA065742
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA065742
STATE BOARD OF MEDICINE
PA
01
—
OA006939
STATE BOARD OF OSTEOPATHIC MEDICINE
PA
Enumeration date
01/16/2023
Last updated
10/13/2024
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