Provider Demographics
NPI:1275118242
Name:IOVANNA, KIRAH (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KIRAH
Middle Name:
Last Name:IOVANNA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565-9219
Mailing Address - Country:US
Mailing Address - Phone:570-561-2990
Mailing Address - Fax:
Practice Address - Street 1:374 MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-9219
Practice Address - Country:US
Practice Address - Phone:516-488-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023056363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health