Provider Demographics
NPI:1740386937
Name:GRESS, KATHRYN JEAN (RNCBSNMA)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:JEAN
Last Name:GRESS
Suffix:
Gender:F
Credentials:RNCBSNMA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:THE GRESS MOUNTAIN RANCH 3264 HIGHLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-2606
Mailing Address - Country:US
Mailing Address - Phone:610-398-2122
Mailing Address - Fax:610-398-1363
Practice Address - Street 1:THE GRESS MOUNTAIN RANCH 3264 HIGHLAND ROAD
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-2606
Practice Address - Country:US
Practice Address - Phone:610-398-2122
Practice Address - Fax:610-398-1363
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA242904-L364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS39091Medicare ID - Type Unspecified
PA904238Medicare ID - Type Unspecified