Provider Demographics
NPI:1174624696
Name:KELL, NELSON A (MED)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:A
Last Name:KELL
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 AUGUST DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1511
Mailing Address - Country:US
Mailing Address - Phone:215-396-2720
Mailing Address - Fax:215-322-6067
Practice Address - Street 1:1880 AUGUST DR
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1511
Practice Address - Country:US
Practice Address - Phone:215-396-2720
Practice Address - Fax:215-322-6067
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005817L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical