MEDICARE: JODI L KNEISLY 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	363LG0600X	Gerontology Nurse Practitioner	RN556458	PA

General Provider Information

NPI Number	:	1790430502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI L KNEISLY CRNP

Provider Business Mailing Address
First Line	:	429 4TH AVE FL 7
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15219-1500
Country	:	US
Telephone Number	:	888-731-8994
Fax Number	:

Provider Business Practice Location Address
First Line	:	239 E BROWN ST
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-3005
Country	:	US
Telephone Number	:	272-212-3872
Fax Number	:	866-230-5974

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

Provider Enumeration Date	:	02/21/2022
Last Update Date	:	01/06/2026

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