Provider Demographics
NPI:1770253304
Name:KISH, MIKAYLA (CRNP)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:KISH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1605 N CEDAR CREST BLVD STE 110B
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:6081 HAMILTON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:WESCOSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18106-9801
Practice Address - Country:US
Practice Address - Phone:610-395-0600
Practice Address - Fax:610-395-9473
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP024440363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner