Healthcare Provider Details

I. General information

NPI: 1356974893
Provider Name (Legal Business Name): SECRET COLE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 LISBURN RD
CAMP HILL PA
17011-8005
US

IV. Provider business mailing address

611 PROCTOR LN
COATESVILLE PA
19320-5836
US

V. Phone/Fax

Practice location:
  • Phone: 717-737-4531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNPPA075943
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP035751
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN705696
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: