Provider Demographics
NPI:1598016958
Name:KALNOSKI, KEVIN P (CRNP)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:P
Last Name:KALNOSKI
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 JAY ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-1924
Mailing Address - Country:US
Mailing Address - Phone:717-454-8379
Mailing Address - Fax:717-560-2044
Practice Address - Street 1:864 JAY ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-1924
Practice Address - Country:US
Practice Address - Phone:717-454-8379
Practice Address - Fax:717-560-2044
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012141363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health