Healthcare Provider Details

I. General information

NPI: 1639811193
Provider Name (Legal Business Name): STEPHANIE KOCHERSPERGER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 S BETHLEHEM PIKE
AMBLER PA
19002-5821
US

IV. Provider business mailing address

2333 KENDERTON AVE
ABINGTON PA
19001-2432
US

V. Phone/Fax

Practice location:
  • Phone: 215-767-7096
  • Fax:
Mailing address:
  • Phone: 215-817-7946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP025535
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: