Healthcare Provider Details

I. General information

NPI: 1023719697
Provider Name (Legal Business Name): YATTA KATHERINE CROSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 OLD YORK RD
JENKINTOWN PA
19046-1601
US

IV. Provider business mailing address

1731 ASHBOURNE RD
ELKINS PARK PA
19027-2535
US

V. Phone/Fax

Practice location:
  • Phone: 215-886-2923
  • Fax:
Mailing address:
  • Phone: 267-283-7811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP019954
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: