Healthcare Provider Details

I. General information

NPI: 1619575768
Provider Name (Legal Business Name): KARA ELYSE CUNNINGHAM CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARA ELYSE CRISWELL RN

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 NORMAN DR
LEBANON PA
17042-7481
US

IV. Provider business mailing address

680 BLAIR MILL RD
HORSHAM PA
19044-2223
US

V. Phone/Fax

Practice location:
  • Phone: 717-639-3230
  • Fax: 717-274-1659
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN633646
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP022828
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: