Provider Demographics
NPI:1477311603
Name:WILL, KIM CORBY (CRNP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:CORBY
Last Name:WILL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:793 OLD ROUTE 119 HWY N
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-1372
Mailing Address - Country:US
Mailing Address - Phone:724-465-5576
Mailing Address - Fax:724-465-6379
Practice Address - Street 1:490 JEFFERS ST
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2438
Practice Address - Country:US
Practice Address - Phone:814-371-1100
Practice Address - Fax:724-371-3671
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP029159363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health