Provider Demographics
NPI:1124494869
Name:VELOTT, KIMNGAN THI (CRNP)
Entity type:Individual
Prefix:MS
First Name:KIMNGAN
Middle Name:THI
Last Name:VELOTT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KIM NGAN (KIMNGAN)
Other - Middle Name:THI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:409 S 2ND ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-724-6500
Mailing Address - Fax:717-721-6510
Practice Address - Street 1:2401 PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9303
Practice Address - Country:US
Practice Address - Phone:717-686-9842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015392363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103105401Medicaid
PA103105401Medicaid