Provider Demographics
NPI:1013999762
Name:KISER, CONNIE D (DNP, CRNP)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:D
Last Name:KISER
Suffix:
Gender:F
Credentials:DNP, CRNP
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2160 STATE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-1812
Mailing Address - Country:US
Mailing Address - Phone:223-287-8155
Mailing Address - Fax:717-312-3143
Practice Address - Street 1:2160 STATE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-1812
Practice Address - Country:US
Practice Address - Phone:717-851-2441
Practice Address - Fax:717-312-3143
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP004297M363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA012961E3Medicare PIN
PA012961FLTMedicare PIN
S60669Medicare UPIN