Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | SP007450 | PA |
NPI | 1023140878 |
---|---|
Provider Name | Mrs. Kimberly O'sullivan-Smith |
First Address | Allentown, PA 18105-1754 |
Second Address | Bethlehem, PA 18017-7300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 13/04/2020 |