Provider Demographics
NPI:1386387298
Name:ALVEN, KELLY (NP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ALVEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MILBOB DRIVE
Mailing Address - Street 2:
Mailing Address - City:IVYLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18974
Mailing Address - Country:US
Mailing Address - Phone:215-429-7269
Mailing Address - Fax:
Practice Address - Street 1:15 MILBOB DRIVE
Practice Address - Street 2:
Practice Address - City:IVYLAND
Practice Address - State:PA
Practice Address - Zip Code:18974
Practice Address - Country:US
Practice Address - Phone:215-429-7269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily