Provider Demographics
NPI:1396214557
Name:KANNAPEL, TIMOTHY (CRNP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:KANNAPEL
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 KING WAY
Mailing Address - Street 2:
Mailing Address - City:BREINIGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18031-1482
Mailing Address - Country:US
Mailing Address - Phone:502-931-4024
Mailing Address - Fax:
Practice Address - Street 1:7248 TILGHMAN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9355
Practice Address - Country:US
Practice Address - Phone:610-336-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-17
Last Update Date:2018-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019617363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner