=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962391995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHY LIVING AT PMSI
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2025
-----------------------------------------------------
Last Update Date | 07/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1566 MEDICAL DR STE 201
-----------------------------------------------------
City | POTTSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19464-3229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-224-9655
-----------------------------------------------------
Fax | 610-327-8160
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1566 MEDICAL DR STE 201
-----------------------------------------------------
City | POTTSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19464-3229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-224-9655
-----------------------------------------------------
Fax | 610-327-8160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KIMBERLY CLARE SLIFER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-327-4200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WD0400X
-----------------------------------------------------
Taxonomy Name | Diabetes Educator Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------