Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | SP023745 | PA |
NPI | 1033788963 |
---|---|
Provider Name | Kristen Rebecca Messick |
First Address | Glen Mills, PA 19342-1904 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2021 |
Last Update Date | 24/06/2021 |