Healthcare Provider Details

I. General information

NPI: 1114622172
Provider Name (Legal Business Name): KAITLIN C KEGERREIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN C GANOE

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 ALEXANDER SPRING RD
CARLISLE PA
17015-6940
US

IV. Provider business mailing address

361 ALEXANDER SPRING RD
CARLISLE PA
17015-6940
US

V. Phone/Fax

Practice location:
  • Phone: 717-782-5118
  • Fax: 717-782-5854
Mailing address:
  • Phone: 717-782-5118
  • Fax: 717-782-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN707153
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: