1437936390 NPI number — KATIE M FOLKENROTH FNP

Table of content: KATIE M FOLKENROTH FNP (NPI 1437936390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437936390 NPI number — KATIE M FOLKENROTH FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOLKENROTH
Provider First Name:
KATIE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1437936390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 BROOKHILL SQUARE SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGARLOAF
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18249-1010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-459-0029
Provider Business Mailing Address Fax Number:
570-454-5757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 S MARKET STREET
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
MECHANICSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17055-4748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-458-5407
Provider Business Practice Location Address Fax Number:
717-610-6955
Provider Enumeration Date:
09/13/2023

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: 163W00000X , with the licence number:  RN703424 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: SP028171 , 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)