Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS017147 | PA |
N | 207QS0010X | Family Doctor - Sports Medicine | OS017147 | PA |
NPI | 1073877981 |
---|---|
Provider Name | Abbie Leigh Kelley |
First Address | York, PA 17402-4723 |
Second Address | York, PA 17402-4723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2012 |
Last Update Date | 29/05/2019 |