Provider Demographics
NPI:1689621286
Name:TUMELTY, KATHRYN SPIKER (NP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:SPIKER
Last Name:TUMELTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 COTTMAN AVE
Mailing Address - Street 2:FOX CHASE CANCER CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2497
Mailing Address - Country:US
Mailing Address - Phone:215-214-3736
Mailing Address - Fax:215-214-4017
Practice Address - Street 1:333 COTTMAN AVE
Practice Address - Street 2:FOX CHASE CANCER CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2497
Practice Address - Country:US
Practice Address - Phone:215-214-3736
Practice Address - Fax:215-214-4017
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-00980363L00000X
PASP009364363LF0000X
PARN580910L363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q69676Medicare UPIN