Provider Demographics
NPI:1790430502
Name:KNEISLY, JODI L (CRNP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:KNEISLY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Mailing Address - Street 1:801 OSTRUM ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:484-526-6048
Mailing Address - Fax:833-213-6428
Practice Address - Street 1:239 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3005
Practice Address - Country:US
Practice Address - Phone:272-212-3872
Practice Address - Fax:866-230-5974
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN556458363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology