Provider Demographics
NPI:1639380439
Name:WYMBS, KERRY MART (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:MART
Last Name:WYMBS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MRS
Other - First Name:KERRY
Other - Middle Name:MART
Other - Last Name:ASHCROFT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:103 HANOVER CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5705
Mailing Address - Country:US
Mailing Address - Phone:732-801-8708
Mailing Address - Fax:
Practice Address - Street 1:34TH STREET & CIVIC CENTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-2754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009303363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics