Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | SP019626 | PA |
NPI | 1083183024 |
---|---|
Provider Name | Mrs. Kelly Ann Shearer |
First Address | Washington, PA 15301-2111 |
Second Address | Washington, PA 15301-2111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2018 |
Last Update Date | 12/11/2020 |