Provider Demographics
NPI:1265197271
Name:DEMILLE, KIRSTY M (CRNP)
Entity type:Individual
Prefix:
First Name:KIRSTY
Middle Name:M
Last Name:DEMILLE
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:KIRSTY
Other - Middle Name:M
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-629-2282
Mailing Address - Fax:
Practice Address - Street 1:325 W BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5526
Practice Address - Country:US
Practice Address - Phone:484-626-9250
Practice Address - Fax:484-626-9255
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024300363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP024300OtherSTATE LICENSE