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General NPI Number Information
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NPI Number | 1285362475
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Entity Type | Individual
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Provider Name | KATHRYN LYNN GAVLICK PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 60 GLENMAURA NATIONAL BOULEVARD
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City | MOOSIC
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State | PA
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Zip | 18507-0030
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Country | US
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Telephone | 570-301-5047
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Fax |
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Provider Business Mailing Address
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Address Line | 317 NORTH ST
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City | WEST PITTSTON
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State | PA
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Zip | 18643-2127
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Country | US
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Telephone | 570-592-7985
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | SP025763
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP025763
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License Number State | PA
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