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General NPI Number Information
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NPI Number | 1134199235
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Entity Type | Individual
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Provider Name | TINA MARIE DOUD-KEARNS FNPC
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Gender | Female
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 6 RIVERSIDE PLZ
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City | BLOSSBURG
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State | PA
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Zip | 16912-1137
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Country | US
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Telephone | 570-638-2174
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Fax |
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Provider Business Mailing Address
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Address Line | 40 W WELLSBORO ST
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City | MANSFIELD
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State | PA
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Zip | 16933-1411
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Country | US
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Telephone | 570-662-1945
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2164
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License Number State | SC
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