Provider Demographics
NPI:1568554145
Name:HILL, KATHLEEN A (RN, CRNP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:HILL
Suffix:
Gender:F
Credentials:RN, CRNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 MONUMENT RD STE 500
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1701
Mailing Address - Country:US
Mailing Address - Phone:855-478-8208
Mailing Address - Fax:
Practice Address - Street 1:150 MONUMENT RD STE 500
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1701
Practice Address - Country:US
Practice Address - Phone:855-478-8208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP003961H363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA042145Medicare PIN
PA042145L66Medicare ID - Type Unspecified