Provider Demographics
NPI:1851139349
Name:KEGERREIS, KRISTYN LEIGH (CRNP)
Entity type:Individual
Prefix:
First Name:KRISTYN
Middle Name:LEIGH
Last Name:KEGERREIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:17320-9510
Mailing Address - Country:US
Mailing Address - Phone:717-339-3175
Mailing Address - Fax:
Practice Address - Street 1:4910 FAIRFIELD RD STE A
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:PA
Practice Address - Zip Code:17320-9510
Practice Address - Country:US
Practice Address - Phone:717-339-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily