Provider Demographics
NPI:1972160398
Name:NARDIS, KIMBERLY (CRNP, NNP-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:NARDIS
Suffix:
Gender:F
Credentials:CRNP, NNP-BC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LONG
Other - Last Name:NARDIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RNC-NIC
Mailing Address - Street 1:6216 CHARING CROSS
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-5205
Mailing Address - Country:US
Mailing Address - Phone:717-418-0951
Mailing Address - Fax:
Practice Address - Street 1:801 OSTRUM ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1000
Practice Address - Country:US
Practice Address - Phone:484-526-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020006363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care