Healthcare Provider Details

I. General information

NPI: 1831198688
Provider Name (Legal Business Name): KATHLEEN ANN SIMON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ROOSEVELT AVE
YORK PA
17404-2244
US

IV. Provider business mailing address

3203 MIDDLE RD
COLUMBUS IN
47203-4427
US

V. Phone/Fax

Practice location:
  • Phone: 717-566-2503
  • Fax: 717-553-1269
Mailing address:
  • Phone: 812-373-2700
  • Fax: 812-373-2710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP029609
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71000664
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: