Healthcare Provider Details

I. General information

NPI: 1932614260
Provider Name (Legal Business Name): KANNIKA M OSBORNE WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KANNIKA STORY

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 INNOVATION BLVD FL 2
STATE COLLEGE PA
16803-6611
US

IV. Provider business mailing address

330 INNOVATION BLVD FL 2
STATE COLLEGE PA
16803-6611
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone: 888-731-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP018390
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: