Healthcare Provider Details

I. General information

NPI: 1265342943
Provider Name (Legal Business Name): KRISTIN WILHIDE RN, BSN, CPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 INDEPENDENCE WAY
NEWARK DE
19713-1159
US

IV. Provider business mailing address

324 LINE RD
KENNETT SQUARE PA
19348-2220
US

V. Phone/Fax

Practice location:
  • Phone: 302-894-1001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN635384
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: