Provider Demographics
NPI:1922007731
Name:FALLER, KATHRYN M (CRNP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:M
Last Name:FALLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 CEDARCREST DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-7302
Mailing Address - Country:US
Mailing Address - Phone:814-504-4034
Mailing Address - Fax:
Practice Address - Street 1:737 CEDARCREST DR
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-7302
Practice Address - Country:US
Practice Address - Phone:814-504-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005192B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002105252OtherHIGHMARK
PAP20639Medicare UPIN
PA002105252OtherHIGHMARK
PAS20639Medicare UPIN