Individual
GRACE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
950 S OCTORARA TRL, PARKESBURG, PA 19365-2100
(610) 857-6639
Mailing address
950 S OCTORARA TRL, PARKESBURG, PA 19365-2100
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
05/08/2026
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