Provider Demographics
NPI:1619545274
Name:KEHOE, KRISTINA L (RN)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:L
Last Name:KEHOE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 S ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-9518
Mailing Address - Country:US
Mailing Address - Phone:570-881-7845
Mailing Address - Fax:
Practice Address - Street 1:1910 MANADA ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-2948
Practice Address - Country:US
Practice Address - Phone:877-988-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN332860L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse