Provider Demographics
NPI:1386075216
Name:WYNEGAR, KELLI S (CRNP)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:S
Last Name:WYNEGAR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:S
Other - Last Name:KASHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-7676
Mailing Address - Fax:717-461-7155
Practice Address - Street 1:25 MONUMENT RD STE 295
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5049
Practice Address - Country:US
Practice Address - Phone:717-812-7676
Practice Address - Fax:717-461-7155
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013414363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028883820001Medicaid
PAP01365795Medicare PIN