1649235623 NPI number — KRISTY WASHINGTON CRNP

Table of content: KRISTY WASHINGTON CRNP (NPI 1649235623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649235623 NPI number — KRISTY WASHINGTON CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASHINGTON
Provider First Name:
KRISTY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

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:
1649235623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 BATTENKILL DR
Provider Second Line Business Mailing Address:
SUITE 2020
Provider Business Mailing Address City Name:
DOUGLASSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19518-8706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-385-7751
Provider Business Mailing Address Fax Number:
610-385-7751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 S 7TH AVE
Provider Second Line Business Practice Location Address:
SUITE 2020
Provider Business Practice Location Address City Name:
WEST READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19611-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-375-6565
Provider Business Practice Location Address Fax Number:
610-375-2065
Provider Enumeration Date:
04/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  SP-008596 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: SP010691 , 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)