Provider Demographics
NPI:1427533934
Name:LIDARD KOLE, KATHRYN ANN (CRNP, RN)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:LIDARD KOLE
Suffix:
Gender:F
Credentials:CRNP, RN
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:LIDARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-1539
Practice Address - Country:US
Practice Address - Phone:570-271-6429
Practice Address - Fax:570-271-6854
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR199260163W00000X, 363LA2100X
TXAP145021363LA2100X
PASP026072363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care