Provider Demographics
NPI:1326753336
Name:HAUMESSER, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HAUMESSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 JOHNSONBURG RD STE 160
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3484
Mailing Address - Country:US
Mailing Address - Phone:814-594-7458
Mailing Address - Fax:
Practice Address - Street 1:761 JOHNSONBURG RD STE 160
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3484
Practice Address - Country:US
Practice Address - Phone:814-788-8777
Practice Address - Fax:814-788-8770
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2024-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065742363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA065742OtherSTATE BOARD OF MEDICINE
PAOA006939OtherSTATE BOARD OF OSTEOPATHIC MEDICINE