Individual
KELLY S EATON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1705 WARREN AVE STE 101-103, WILLIAMSPORT, PA 17701-2647
(570) 321-2020
Mailing address
1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-1900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA056608
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA056608
STATE LICENSE
PA
Enumeration date
10/03/2013
Last updated
08/10/2026
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