Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | SP023529 | PA |
NPI | 1003484445 |
---|---|
Provider Name | John Joseph Kerprich JR. |
First Address | East Stroudsburg, PA 18301-3006 |
Second Address | East Stroudsburg, PA 18301-3006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2021 |
Last Update Date | 26/07/2021 |