Provider Demographics
NPI:1013259985
Name:YESAVAGE, KATHLEEN (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:YESAVAGE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:JOY
Other - Last Name:COLBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:4300 LONDONDERRY RD STE 302
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5317
Mailing Address - Country:US
Mailing Address - Phone:717-724-6780
Mailing Address - Fax:717-724-6781
Practice Address - Street 1:4300 LONDONDERRY RD STE 302
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5317
Practice Address - Country:US
Practice Address - Phone:717-724-6780
Practice Address - Fax:717-724-6781
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012360363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner