MEDICARE: ALICIA KISTLER

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP032946	PA

General Provider Information

NPI Number	:	1619495009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA KISTLER

Provider Business Mailing Address
First Line	:	2214 RISING SUN RD
Second Line	:
City	:	SLATINGTON
State	:	PA
Zip	:	18080-4038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 E CATHEDRAL RD STE 45
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2128
Country	:	US
Telephone Number	:	484-258-9271
Fax Number	:

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

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	04/01/2026

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Directions to “ ALICIA KISTLER ” Practice Location

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