Provider Demographics
NPI:1972640175
Name:MORAN, KERITH LYNN (CNM)
Entity type:Individual
Prefix:MS
First Name:KERITH
Middle Name:LYNN
Last Name:MORAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:625 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-1720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2560 KNIGHTS RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3400
Practice Address - Country:US
Practice Address - Phone:215-245-4334
Practice Address - Fax:215-245-7856
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008606L367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife