Healthcare Provider Details

I. General information

NPI: 1386550572
Provider Name (Legal Business Name): KIMBERLY JOAN MASON CNS, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

2213 WISTERIA AVE
GLENSIDE PA
19038-5115
US

V. Phone/Fax

Practice location:
  • Phone: 267-257-5677
  • Fax:
Mailing address:
  • Phone: 215-884-1325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberCNS000218
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: