Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | VP005115B | PA |
NPI | 1003885435 |
---|---|
Provider Name | Ms. Kelly R. Haikes |
First Address | Danville, PA 17822-4903 |
Second Address | Scranton, PA 18503-1987 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 19/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S98937 | (02) |