Kelly M Boesch, CRNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

SP013294 Issued in PA

Practice address

618 Cornwall Rd
Building 2
Lebanon, PA 17042-7089

Phone

(717) 279-6700

Fax

(717) 279-6759

NPI assigned

Aug 27, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kelly M Peterson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415232000000",
    "number": "1528492535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 300",
            "address_2": "4TH & WILLOW STREETS",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170420300",
            "telephone_number": "717-270-7780",
            "fax_number": "717-274-9746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 CORNWALL RD",
            "address_2": "BUILDING 2",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427089",
            "telephone_number": "717-279-6700",
            "fax_number": "717-279-6759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOESCH",
        "first_name": "KELLY",
        "middle_name": "M",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-27",
        "last_updated": "2014-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "PA",
            "license": "SP013294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "SP013294",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102888103 0001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "PETERSON",
            "middle_name": "M",
            "credential": "CRNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Wendy Blauch
• Tonya Rae Blazina, BA
• Michael Blessing
• Megan Bloomquist, D.D.S.
• Emily Boehler, LPC
• Patricia Bogrette, M.ED, LBS, BCBA
• Claudia Bohdal
• Audrey Irene Boltz, MSW, LSW
• Joshua Paul Bombax, PHARMD
• Maritza C Bonilla

• Pediatric Nurse Practitioner in Lebanon, PA
• Providers in Lebanon, PA by specialty
• Pediatric Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.