1073639258 NPI number — PEDIATRIC PARTNERS,P.C.

Table of content: MRS. ALEXANDRA KESLER JOHNSON MSN, NNP-BC (NPI 1063910503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073639258 NPI number — PEDIATRIC PARTNERS,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC PARTNERS,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073639258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1575 HIGHLANDS DR
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
LITITZ
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17543-7507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-627-1133
Provider Business Mailing Address Fax Number:
717-627-3762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1575 HIGHLANDS DR
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
LITITZ
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17543-7507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-627-1133
Provider Business Practice Location Address Fax Number:
717-627-3762
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLEMING
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
717-627-1133

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  MD025637E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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