MEDICARE: KRISTIN MECKES CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	SP014553	PA
2	363L00000X	Nurse Practitioner	SP014553	PA

General Provider Information

NPI Number	:	1508256488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MECKES CRNP

Provider Business Mailing Address
First Line	:	575 S 9TH ST STE 1
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-2517
Country	:	US
Telephone Number	:	570-645-1990
Fax Number	:	570-645-1995

Provider Business Practice Location Address
First Line	:	575 S 9TH ST STE 1
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-2517
Country	:	US
Telephone Number	:	570-645-1990
Fax Number	:	570-645-1995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2015
Last Update Date	:	09/05/2023

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