Provider Demographics
NPI:1598243040
Name:DEFILIPPIS, KELLEY (CRNP)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:DEFILIPPIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:28 INDEPENDENCE RD
Mailing Address - Street 2:
Mailing Address - City:AVELLA
Mailing Address - State:PA
Mailing Address - Zip Code:15312-2369
Mailing Address - Country:US
Mailing Address - Phone:412-217-6685
Mailing Address - Fax:
Practice Address - Street 1:10440 LITTLE PATUXENT PKWY STE 3000
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3561
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR259982363LF0000X
PASP019031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP019031OtherSTATE LICENSE
MDR259982OtherSTATE LICENSE