Provider Demographics
NPI:1063447852
Name:DIVELY, KRISTI L (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:L
Last Name:DIVELY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 S. STATE STREET
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522
Mailing Address - Country:US
Mailing Address - Phone:717-859-8000
Mailing Address - Fax:717-859-6313
Practice Address - Street 1:1170 S STATE ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2601
Practice Address - Country:US
Practice Address - Phone:717-859-8000
Practice Address - Fax:717-859-6313
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012313207V00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology