Provider Demographics
NPI:1154344257
Name:CARR, KELLY S (CRNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:CARR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W WELLSBORO ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933-1411
Mailing Address - Country:US
Mailing Address - Phone:570-662-1945
Mailing Address - Fax:
Practice Address - Street 1:32 E LAWRENCE RD
Practice Address - Street 2:LAWRENCEVILLE LAUREL HEALTH CENTER
Practice Address - City:LAWRENCEVILLE
Practice Address - State:PA
Practice Address - Zip Code:16929-8801
Practice Address - Country:US
Practice Address - Phone:570-827-0128
Practice Address - Fax:570-827-0129
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101654306Medicaid
PA101654306Medicaid
P32171Medicare UPIN