Healthcare Provider Details

I. General information

NPI: 1376141713
Provider Name (Legal Business Name): KIMBERLY KATHLEEN DEUTSCH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 10/08/2023
Certification Date: 10/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 GREEN AVE EXT STE 112
LEWISTOWN PA
17044-3404
US

IV. Provider business mailing address

90 WALNUT RD
LEWISTOWN PA
17044-2600
US

V. Phone/Fax

Practice location:
  • Phone: 717-280-6456
  • Fax: 717-323-1748
Mailing address:
  • Phone: 717-280-6456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN580892
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP022769
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: