Healthcare Provider Details

I. General information

NPI: 1851139349
Provider Name (Legal Business Name): KRISTYN LEIGH KEGERREIS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 FAIRFIELD RD STE A
FAIRFIELD PA
17320-9510
US

IV. Provider business mailing address

4910 FAIRFIELD RD
FAIRFIELD PA
17320-9510
US

V. Phone/Fax

Practice location:
  • Phone: 717-339-3175
  • Fax:
Mailing address:
  • Phone: 717-339-3175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP030086
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: