Healthcare Provider Details

I. General information

NPI: 1659257996
Provider Name (Legal Business Name): KRISTEN B FAHEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 MAIN ST
SLATINGTON PA
18080-1458
US

IV. Provider business mailing address

214 COLLEGE PARK PLZ
JOHNSTOWN PA
15904-2833
US

V. Phone/Fax

Practice location:
  • Phone: 610-224-9311
  • Fax: 814-266-2880
Mailing address:
  • Phone: 814-262-0025
  • Fax: 814-266-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5025240
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP033784
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number743098
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number858753
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: