Individual
KELLY M. DISTELRATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3601 MCKNIGHT EAST DR, PITTSBURGH, PA 15237-6400
(412) 369-9943
(412) 369-9447
Mailing address
8150 PERRY HWY STE 201, PITTSBURGH, PA 15237-5200
(724) 741-0044
(412) 369-9566
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN.CNP.0027728
OH
363LF0000X
Family Nurse Practitioner
Primary
SP022823
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103876840-0001
—
PA
Enumeration date
10/14/2020
Last updated
01/17/2024
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