Individual
GRACE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
895 EAST MAIN STREET, EPHRATA, PA 17522-2545
(717) 721-4585
(717) 721-4597
Mailing address
895 EAST MAIN STREET, EPHRATA, PA 17522-2545
(717) 721-4585
(717) 721-4597
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MA067581
PA
207RC0000X
Cardiovascular Disease Physician
Primary
C5-0012333
DE
363A00000X
Physician Assistant
Primary
MA067581
PA
Other
Enumeration date
09/18/2025
Last updated
07/10/2026
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