Provider Demographics
NPI:1043444672
Name:BALTAZAR, KATHERINE KILCHMANN (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:KILCHMANN
Last Name:BALTAZAR
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 PINE LN
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2814
Mailing Address - Country:US
Mailing Address - Phone:267-979-9524
Mailing Address - Fax:
Practice Address - Street 1:1003 EASTON RD BLDG C-104
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-2027
Practice Address - Country:US
Practice Address - Phone:267-979-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010164363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health