Healthcare Provider Details

I. General information

NPI: 1053078956
Provider Name (Legal Business Name): KRUPA CHIEMELU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6129 PALMETTO ST
PHILADELPHIA PA
19111-5729
US

IV. Provider business mailing address

6129 PALMETTO ST
PHILADELPHIA PA
19111-5729
US

V. Phone/Fax

Practice location:
  • Phone: 848-248-8844
  • Fax:
Mailing address:
  • Phone: 848-248-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number478366
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0031090
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP033309
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: