Individual
KELLY LOREN MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9104 BABCOCK BLVD, SUITE 2120, PITTSBURGH, PA 15237-5818
(412) 367-0600
(412) 367-7079
Mailing address
7500 BROOKTREE ROAD, SUITE 320, WEXFORD, PA 15090-5818
(412) 367-0600
(412) 367-7079
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA051371
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1490788025
GATEWAY MEDICARE ASSURED
—
01
—
1497088025
AETNA BETTER HEALTH
—
05
—
1497088025
—
PA
Enumeration date
09/15/2009
Last updated
12/19/2018
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