Provider Demographics
NPI:1215518543
Name:KELLETT, CHRISTIN NICHOLE (CRNP,FNP-BC,FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIN
Middle Name:NICHOLE
Last Name:KELLETT
Suffix:
Gender:F
Credentials:CRNP,FNP-BC,FNP-C
Other - Prefix:
Other - First Name:CHRISTIN
Other - Middle Name:NICHOLE
Other - Last Name:HEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1120 CENTRE TPKE
Mailing Address - Street 2:
Mailing Address - City:ORWIGSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17961-9191
Mailing Address - Country:US
Mailing Address - Phone:570-366-2613
Mailing Address - Fax:
Practice Address - Street 1:1120 CENTRE TPKE
Practice Address - Street 2:
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17961-9191
Practice Address - Country:US
Practice Address - Phone:570-366-2613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023547363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily