Individual
KELLEY KOMETA SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1259 S CEDAR CREST BLVD STE 230, ALLENTOWN, PA 18103-6376
(610) 402-5900
(610) 402-4650
Mailing address
2100 MACK BLVD FL 4, ALLENTOWN, PA 18103-5622
(484) 884-4500
(484) 884-0699
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN663117
PA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP032895
PA
Other
Enumeration date
04/08/2025
Last updated
07/30/2025
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