Provider Demographics
NPI:1902916414
Name:KRAELING, KELLI J (CRNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:J
Last Name:KRAELING
Suffix:
Gender:F
Credentials:CRNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-333-5888
Mailing Address - Fax:814-333-5887
Practice Address - Street 1:765 LIBERTY ST STE 202
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2568
Practice Address - Country:US
Practice Address - Phone:814-333-5888
Practice Address - Fax:814-333-5887
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN510515L363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q57716Medicare UPIN
PA096336SA6Medicare ID - Type Unspecified