Provider Demographics
NPI:1508368994
Name:MALLARI, KRYSHA PATRIZ (CRNP)
Entity Type:Individual
Prefix:
First Name:KRYSHA PATRIZ
Middle Name:
Last Name:MALLARI
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 1:2000 MARKET ST STE 780
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-3224
Mailing Address - Country:US
Mailing Address - Phone:215-288-3303
Mailing Address - Fax:215-288-0384
Practice Address - Street 1:5364 JACKSON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-1565
Practice Address - Country:US
Practice Address - Phone:215-288-3303
Practice Address - Fax:215-288-0384
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELP-0000238363L00000X, 363LA2200X, 363LG0600X, 363LP2300X
PASP018407363LA2200X, 363LG0600X, 363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care