Provider Demographics
NPI:1093128753
Name:SPANGLER, KELLY JORDAN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:JORDAN
Last Name:SPANGLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JORDAN
Other - Last Name:MAHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1599 SOMERSET AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-1745
Mailing Address - Country:US
Mailing Address - Phone:814-341-1059
Mailing Address - Fax:
Practice Address - Street 1:1599 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-1745
Practice Address - Country:US
Practice Address - Phone:814-467-5600
Practice Address - Fax:814-467-5605
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical