Healthcare Provider Details

I. General information

NPI: 1225493695
Provider Name (Legal Business Name): KERITH DUGGAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 N 6TH ST
PHILADELPHIA PA
19140-2319
US

IV. Provider business mailing address

4417 N 6TH ST
PHILADELPHIA PA
19140-2319
US

V. Phone/Fax

Practice location:
  • Phone: 215-302-3600
  • Fax: 215-329-2369
Mailing address:
  • Phone: 215-302-3150
  • Fax: 215-329-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP017254
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR219689
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: