Healthcare Provider Details

I. General information

NPI: 1710896402
Provider Name (Legal Business Name): JACOB KYLE FAUST PMHNP-BC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 MARIA HALL DR
DANVILLE PA
17821-1304
US

IV. Provider business mailing address

358 SUNBURY RD
DANVILLE PA
17821-8789
US

V. Phone/Fax

Practice location:
  • Phone: 570-953-8552
  • Fax:
Mailing address:
  • Phone: 570-394-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberSP036645
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: