Healthcare Provider Details

I. General information

NPI: 1265802953
Provider Name (Legal Business Name): KALIA C. COLE-AVERY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WALNUT ST 14TH FLOOR
PHILADELPHIA PA
19107-5176
US

IV. Provider business mailing address

800 WALNUT ST 14TH FLOOR
PHILADELPHIA PA
19107-5176
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-8000
  • Fax:
Mailing address:
  • Phone: 215-829-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0070537
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN608307
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberSP015335
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberLH-0010264
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: