Provider Demographics
NPI:1689127789
Name:GEVARAS, KIMBERLEE LYN (FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:LYN
Last Name:GEVARAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 MOUNT COBB RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18436-3223
Mailing Address - Country:US
Mailing Address - Phone:845-649-0003
Mailing Address - Fax:
Practice Address - Street 1:1650 MOUNT COBB RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18436-3223
Practice Address - Country:US
Practice Address - Phone:845-649-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22616918163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse