Healthcare Provider Details

I. General information

NPI: 1477402998
Provider Name (Legal Business Name): JESSICA K NATIVIDAD CRNP-FH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 PIERCE ST
KINGSTON PA
18704-5731
US

IV. Provider business mailing address

PO BOX 1885
KINGSTON PA
18704-0885
US

V. Phone/Fax

Practice location:
  • Phone: 570-714-3333
  • Fax: 570-338-3993
Mailing address:
  • Phone: 570-714-3333
  • Fax: 570-338-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP033944
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: