Healthcare Provider Details

I. General information

NPI: 1114684685
Provider Name (Legal Business Name): KRISHAN KECK CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 GRANDVIEW AVE STE 200L
CAMP HILL PA
17011-1746
US

IV. Provider business mailing address

205 GRANDVIEW AVE STE 200L
CAMP HILL PA
17011-1746
US

V. Phone/Fax

Practice location:
  • Phone: 717-648-1269
  • Fax: 717-229-8051
Mailing address:
  • Phone: 717-648-1269
  • Fax: 717-229-8051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP024041
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: