Provider Demographics
NPI:1558250845
Name:DEGEZELLE, KAILEY
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:
Last Name:DEGEZELLE
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 1:240 E MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:MYERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17067-1119
Mailing Address - Country:US
Mailing Address - Phone:484-529-6479
Mailing Address - Fax:
Practice Address - Street 1:2160 STATE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-1812
Practice Address - Country:US
Practice Address - Phone:223-287-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN773601163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse