Provider Demographics
NPI:1376141713
Name:DEUTSCH, KIMBERLY KATHLEEN (PMHNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KATHLEEN
Last Name:DEUTSCH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-2600
Mailing Address - Country:US
Mailing Address - Phone:717-280-6456
Mailing Address - Fax:
Practice Address - Street 1:399 GREEN AVE EXT STE 112
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-3404
Practice Address - Country:US
Practice Address - Phone:717-280-6456
Practice Address - Fax:717-323-1748
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN580892163W00000X
PASP022769363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse