Healthcare Provider Details

I. General information

NPI: 1275783128
Provider Name (Legal Business Name): KIMBERLY BAGGIO CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 DOWLIN FORGE RD
EXTON PA
19341-1550
US

IV. Provider business mailing address

161 DOWLIN FORGE RD
EXTON PA
19341-1550
US

V. Phone/Fax

Practice location:
  • Phone: 610-458-0500
  • Fax: 610-458-0505
Mailing address:
  • Phone: 610-458-0500
  • Fax: 610-458-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number382013
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP017237
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: