Healthcare Provider Details

I. General information

NPI: 1184261489
Provider Name (Legal Business Name): KATHERINE NICOLE PERRY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 STATE RD
LANCASTER PA
17601-1812
US

IV. Provider business mailing address

202 WATERCRESS LN
ELIZABETHTOWN PA
17022-1667
US

V. Phone/Fax

Practice location:
  • Phone: 223-287-8155
  • Fax: 717-312-3143
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP021053
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: