MEDICARE: KAITLYN ELIZABETH MCDERMOTT CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	SP025790	PA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP029219	PA

General Provider Information

NPI Number	:	1407566615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN ELIZABETH MCDERMOTT CRNP

Provider Business Mailing Address
First Line	:	419 UNION ST
Second Line	:
City	:	NEWTOWN
State	:	PA
Zip	:	18940-1465
Country	:	US
Telephone Number	:	267-253-7119
Fax Number	:

Provider Business Practice Location Address
First Line	:	3331 STREET ROAD TWO GREENWOOD SQ
Second Line	:	SUITE 410
City	:	BENSALEM
State	:	PA
Zip	:	19020
Country	:	US
Telephone Number	:	215-245-3525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2022
Last Update Date	:	02/03/2026

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