Provider Demographics
NPI:1821283359
Name:KROSS, KIMBERLY A (DO)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:KROSS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:KROSS-NOVAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:78 OAK ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:PA
Mailing Address - Zip Code:18705-3425
Mailing Address - Country:US
Mailing Address - Phone:570-822-9263
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-9800
Practice Address - Country:US
Practice Address - Phone:570-271-6812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT010390207PE0004X
PAOS014026207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services