Provider Demographics
NPI:1316200611
Name:SLABAUGH, KRISTEN LYNNE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:LYNNE
Last Name:SLABAUGH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LYNNE
Other - Last Name:GLASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:775 S ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5002
Practice Address - Country:US
Practice Address - Phone:717-782-5905
Practice Address - Fax:717-782-5908
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011062363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103015734Medicaid
PA244391Medicare PIN