Provider Demographics
NPI:1194121624
Name:KERLEY, LESA (CRNP)
Entity type:Individual
Prefix:
First Name:LESA
Middle Name:
Last Name:KERLEY
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 1:1263 ELK ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-1312
Mailing Address - Country:US
Mailing Address - Phone:814-437-3674
Mailing Address - Fax:814-437-3677
Practice Address - Street 1:1100 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2029
Practice Address - Country:US
Practice Address - Phone:417-256-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014345363LF0000X
MO2017008862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5004151OtherAETNA
PA1029871390001Medicaid
PA3144591OtherHIGHMARK MEDICARE ADVANTAGE
PA424058OtherUPMC
PA1029871390001Medicaid