Healthcare Provider Details

I. General information

NPI: 1245961804
Provider Name (Legal Business Name): JENNIFER GRACE KAIRYS NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 12/02/2025
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 FRANKLIN ST FL 5
JOHNSTOWN PA
15905-4305
US

IV. Provider business mailing address

1128 FOUR LEAF LN
HOLLIDAYSBURG PA
16648-2501
US

V. Phone/Fax

Practice location:
  • Phone: 814-534-9794
  • Fax:
Mailing address:
  • Phone: 301-401-0191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberSP025982
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: