Individual
KELLY S. MICKULIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3317 PENN AVE, READING, PA 19609-1436
(610) 750-7891
(610) 750-7894
Mailing address
3317 PENN AVE, READING, PA 19609-1436
(610) 750-7891
(610) 750-7894
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA050888
PA
Other
Enumeration date
07/18/2005
Last updated
08/29/2018
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