Organization
LIFE'S JOURNEY OBGYN, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY DAWN DUCKETT D.O. (OWNER)
(814) 371-1900
Entity
Organization
Contact information
Practice address
190 WEST PARK AVENUE, SUITE 9, DUBOIS, PA 15801
(814) 371-1900
(814) 503-8568
Mailing address
190 WEST PARK AVENUE, SUITE 9, DUBOIS, PA 15801
(814) 371-1900
(814) 503-8568
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
OS014455
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102334099001
—
PA
01
—
P00813924
RAILROAD MEDICARE - PALMETTO
PA
Enumeration date
01/15/2013
Last updated
03/04/2013
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