Provider Demographics
NPI:1073043394
Name:MCGRAW, KATHRYN E (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:E
Other - Last Name:MARGELOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:941 PARK DR
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-3445
Practice Address - Country:US
Practice Address - Phone:717-838-6305
Practice Address - Fax:717-838-5332
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN645939363L00000X
PASP017808363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033959920001Medicaid