Provider Demographics
NPI:1164993093
Name:PRINGLE, KA-MEACH
Entity Type:Individual
Prefix:
First Name:KA-MEACH
Middle Name:
Last Name:PRINGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6103 W THOMPSON ST STE A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-4438
Mailing Address - Country:US
Mailing Address - Phone:215-474-3000
Mailing Address - Fax:215-476-0100
Practice Address - Street 1:6103 W THOMPSON ST STE A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-4438
Practice Address - Country:US
Practice Address - Phone:215-474-3000
Practice Address - Fax:215-476-0100
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA31023601376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031466470001Medicaid