Healthcare Provider Details

I. General information

NPI: 1841885209
Provider Name (Legal Business Name): KARA STACY LYTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2021
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRING RIDGE DR STE 102
WYOMISSING PA
19610-3334
US

IV. Provider business mailing address

4416 IRISH CREEK RD
BERNVILLE PA
19506-8313
US

V. Phone/Fax

Practice location:
  • Phone: 484-709-2022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP023168
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: