Healthcare Provider Details

I. General information

NPI: 1982157129
Provider Name (Legal Business Name): KATHLEEN MARIE BEATTY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 W RIDGE PIKE
LIMERICK PA
19468-1711
US

IV. Provider business mailing address

43 W RIDGE PIKE
LIMERICK PA
19468-1711
US

V. Phone/Fax

Practice location:
  • Phone: 610-226-6200
  • Fax: 610-226-6201
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP016763
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN539235
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: