Provider Demographics
NPI:1568074300
Name:CRIPPEN, KRISTINA K
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:K
Last Name:CRIPPEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MANHEIM AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2720
Mailing Address - Country:US
Mailing Address - Phone:717-945-3240
Mailing Address - Fax:
Practice Address - Street 1:50 JAMES BUCHANAN RD
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1132
Practice Address - Country:US
Practice Address - Phone:610-873-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137347261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)