Individual
KELSEY L WILLIARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1072 MARKET ST, SUNBURY, PA 17801-2458
(570) 286-8521
(570) 286-6197
Mailing address
7 DOCK HILL ROAD, MIDDLEBURG, PA 17842-8910
(570) 837-2123
(570) 837-2185
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA059097
PA
363A00000X
Physician Assistant
Primary
OA004178
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033621040012
—
PA
01
—
587565F6K
MEDICARE
PA
Enumeration date
06/02/2017
Last updated
10/05/2023
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