Healthcare Provider Details

I. General information

NPI: 1831882711
Provider Name (Legal Business Name): KAYCIE VAN DRIEL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

2798 RICHLANDTOWN PIKE
COOPERSBURG PA
18036-9644
US

V. Phone/Fax

Practice location:
  • Phone: 866-785-8537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS025937
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: