Provider Demographics
NPI:1487102406
Name:US PUBLIC HEALTH COMMISSION CORPS
Entity type:Organization
Organization Name:US PUBLIC HEALTH COMMISSION CORPS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FATH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:724-747-5221
Mailing Address - Street 1:180 FERNCLIFF RD
Mailing Address - Street 2:PO BOX 274
Mailing Address - City:RICES LANDING
Mailing Address - State:PA
Mailing Address - Zip Code:15357-1167
Mailing Address - Country:US
Mailing Address - Phone:724-747-5221
Mailing Address - Fax:
Practice Address - Street 1:7900 S J STOCK RD
Practice Address - Street 2:INDIAN HEALTH SERVICE, SAN XAVIER HEALTH CLINIC
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-7012
Practice Address - Country:US
Practice Address - Phone:520-295-2481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012937261QU0200X, 261QP0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care