Individual
MRS. KELLY DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1705 WARREN AVE, SUITE 303, WILLIAMSPORT, PA 17701-2665
(570) 326-8500
(570) 326-8049
Mailing address
1201 GRAMPIAN BLVD, SUITE 1K, WILLIAMSPORT, PA 17701-1900
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP013049
PA
Other
Enumeration date
08/13/2013
Last updated
08/13/2013
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