Healthcare Provider Details

I. General information

NPI: 1245420652
Provider Name (Legal Business Name): KIRA FENTON KUHN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

34TH STREET AND CIVIC CENTER BOULEVARD
PHILADELPHIA PA
19104-4399
US

V. Phone/Fax

Practice location:
  • Phone: 267-425-4661
  • Fax: 267-425-4469
Mailing address:
  • Phone: 267-425-4661
  • Fax: 267-425-4469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP011898
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: