Provider Demographics
NPI:1477821510
Name:STACKHOUSE, KATHERINE ISABEL (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ISABEL
Last Name:STACKHOUSE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 1ST AVE
Mailing Address - Street 2:SUITE 805
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1334
Mailing Address - Country:US
Mailing Address - Phone:484-381-2249
Mailing Address - Fax:484-681-2250
Practice Address - Street 1:1150 1ST AVE
Practice Address - Street 2:SUITE 805
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1334
Practice Address - Country:US
Practice Address - Phone:484-381-2249
Practice Address - Fax:484-681-2250
Is Sole Proprietor?:No
Enumeration Date:2011-12-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA231969Medicare PIN