Provider Demographics
NPI:1194733253
Name:YURKO, KELLY ANN (DPM)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:YURKO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1500
Mailing Address - Country:US
Mailing Address - Phone:570-675-9540
Mailing Address - Fax:570-675-9540
Practice Address - Street 1:550 MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1500
Practice Address - Country:US
Practice Address - Phone:570-675-9540
Practice Address - Fax:570-675-9540
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004028-L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAYU807530Medicare ID - Type Unspecified
PAU60227Medicare UPIN