Provider Demographics
NPI:1578693552
Name:PANICHELLI, KRISTY M (MSN, CRNP)
Entity Type:Individual
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First Name:KRISTY
Middle Name:M
Last Name:PANICHELLI
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Gender:F
Credentials:MSN, CRNP
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Mailing Address - Street 1:207 N BROAD ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:610-696-2850
Mailing Address - Fax:610-696-7159
Practice Address - Street 1:915 OLD FERN HILL RD
Practice Address - Street 2:BLDG A, STE 5
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4269
Practice Address - Country:US
Practice Address - Phone:610-696-2850
Practice Address - Fax:610-696-2579
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2023-07-14
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Provider Licenses
StateLicense IDTaxonomies
PASP008027363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032162220001Medicaid