Provider Demographics
NPI:1932614260
Name:OSBORNE, KANNIKA M (WHNP)
Entity type:Individual
Prefix:
First Name:KANNIKA
Middle Name:M
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:KANNIKA
Other - Middle Name:
Other - Last Name:STORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1777 SENTRY PKWY W
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2207
Mailing Address - Country:US
Mailing Address - Phone:267-460-8802
Mailing Address - Fax:215-923-1089
Practice Address - Street 1:1777 SENTRY PKWY W
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2207
Practice Address - Country:US
Practice Address - Phone:267-460-8802
Practice Address - Fax:215-923-1089
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018390363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health